What determines mortality and morbidity rates in non-variceal, non-malignant upper gastrointestinal bleeding treated with urgent surgical operation

Abstract

Background: Despite the advances in treatment modalities, upper gastrointestinal (GI) bleeding is still a significant health issue. We aimed to assess the risk factors on mortality and morbidity rates in the patients that underwent surgery due to non-variceal and non-malignant bleeding from upper gastrointestinal tract. Methods: We retrospectively examined records of 127 cases with non-variceal, non-malignant acute upper GI bleeding in the our University Hospital, General Surgery Clinic between January 1996 and December 2014. Results: Median age was 60 (16-88) years. The most frequent cause of upper gastrointestinal bleeding was duodenal ulcer observed in 93 (73.23%) patients. The most frequent presenting complaint was melena and hematemesis observed in 66 (52%) patients. Primary suturing, bilateral truncal vagotomy and pyloroplasty were the most frequent surgical procedure performed in 79 (62.20%) patients. There were 23 (27.71%) mortalities. Statistically, mortality and morbidity rates were found to be significantly associated with female sex (OR 6.517, 95% CI 1.559 to 27.238, p=0.010), hematemesis at presentation (OR 10.378, 95% CI 1.889 to 57.005, p=0.007), presence of comorbidity (OR 14.131, 95% CI 2.197 to 90.904, p=0.005), and high urea levels (OR 0.937, 95% CI 0.952 to 0.994, p=0.013) prior to operation. Conclusion: In conclusion, although surgical treatment is the most effective method to control active bleeding from the ulcer and to prevent recurrence, it is often associated with high mortality and morbidity risk due to comorbidities; therefore it should be spared for cases for whom endoscopic and interventional radiologic treatment modalities is unsuccessful.

Keywords

• Gastrointestinal
• bleeding
• upper
• surgical treatment
• urgent

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