title: Surgical management of acute upper gastrointestinal bleeding:still a major challenge.
abstract: OBJECTIVE
  Acute upper gastrointestinal bleeding (UGIB) that cannot be managed with conservative interventional techniques is a life-threatening condition. This study assesses patient outcome and the role of different risk factors.
  
  
  METHODS
  We retrospectively analyzed data from 91 patients (58 men, 33 women) admitted between 2000 and 2009 and who underwent surgery for UGIB requiring transfusion.
  
  
  RESULTS
  Mean patient age was 67.4 years. Overall mortality was 34.1%. Causes of bleeding were duodenal ulcer in 57 patients (62.6%) and gastric ulcer in 25 (27.5%). A median number of 21 blood units (range 6-120) were transfused. Surgical treatment consisted of non-resective surgery (52.7%), Billroth II (31.9%), Billroth I (4.4%) or gastric wedge resection (4.4%). The use of anticoagulants (p=0.040), a need for postoperative ventilation (p=0.007) and an intensive care unit (ICU) length of stay >7 days (p=0.004) were identified as significant risk factors for mortality. Transfusions of more than 10 units of blood (p=0.013), the need for further surgery (p=0.021), a prolonged ICU length of stay (p=0.000) and recurrent bleeding (p=0.029) we identified as significant risk factors for postoperative complications (such as pneumonia, sepsis, re-bleeding and anastomotic leakage).
  
  
  CONCLUSIONS
  Over the past decade, mortality has not decreased in patients requiring surgery for acute UGIB despite diagnostic and therapeutic advances, explained by the fact that these cases represent a negative selection of patients after unsuccessful conservative treatment as well as by the rising age of the population and associated increases in comorbidity. Resective surgery, a need for postoperative ventilation and a prolonged ICU length of stay should be added to the list of significant risk factors for mortality.
authors.affiliation: Department of Surgery, University of Luebeck Medical School, Luebeck, Germany. ralf_czymek@web.de
authors.forename: Ralf
authors.initials: R
authors.lastname: Czymek
authors.forename: Anja
authors.initials: A
authors.lastname: Großmann
authors.forename: Uwe
authors.initials: U
authors.lastname: Roblick
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmidt
authors.forename: Frank
authors.initials: F
authors.lastname: Fischer
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Bruch
authors.forename: Philipp
authors.initials: P
authors.lastname: Hildebrand
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D004381:Duodenal Ulcer / Q000150:complications / Q000175:diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005858:Germany; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications / Q000175:diagnosis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants