title: Minimal versus definitive surgery in managing peptic ulcer bleeding: a population-based cohort study.
abstract: OBJECTIVE
  To compare radical surgery with a minimal approach for peptic ulcer bleeding in relation to survival.
  
  
  METHODS
  A Swedish nationwide population-based cohort study from 1987-2008 compared survival after minimal surgery and definitive surgery. The cohort was also stratified into calendar year before and after the year 2000 for subgroup analyses. Data were collected from the Swedish Patient Register. The two surgical groups were matched based on the propensity score to mimic a randomized trial design. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models adjusted for potential confounders.
  
  
  RESULTS
  4,163 patients were included. There were no differences in survival in patients who underwent definitive surgical procedures compared to those who underwent minimal surgery for a bleeding peptic ulcer during the full study period. Using minimal surgery group as the reference, the HRs for death in the definitive surgery group within 30 days, 90 days, 1 year, and 5 years were 0.87 (95% CI 0.72-1.05), 0.93 (0.80-1.09), 1.00 (95% CI 0.87-1.14), and 1.05 (95% CI 0.95-1.16), respectively. The corresponding HRs during the calendar period after the year 2000 were 1.05 (95% CI 0.65-1.69), 1.18 (95% CI 0.81-1.73), 1.17 (0.84-1.62), and 1.27 (95% CI 0.99-1.63), respectively.
  
  
  CONCLUSIONS
  This study found no worse overall survival after minimal surgery compared to more extensive surgery for refractory peptic ulcer bleeding, and indicated better long-term survival in the minimal surgery group during the more recent study period. A minimal approach is probably sufficient in most cases.
authors.affiliation: Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Emma
authors.initials: E
authors.lastname: Sverdén
authors.forename: Anders
authors.initials: A
authors.lastname: Sondén
authors.forename: Ted
authors.initials: T
authors.lastname: Leinsköld
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D006488:Hemostasis, Surgical / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008026:Ligation / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D015999:Multivariate Analysis; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome