The surgical management of acute upper gastrointestinal bleeding: a 12-year experience

Abstract

Introduction: Acute upper gastrointestinal bleeding (AUGIB) is a common reason for admission to gastroenterologists, with only 2% of patients requiring surgical intervention. The aim of this study was to review the surgical management of patients with non-variceal AUGIB in a single institution over a 12-year period and compare practice with recognised regional and national standards.

Materials and methods: Data was collected retrospectively for all patients undergoing surgery for AUGIB between September 1995 and September 2007. Audit standards included the local hospital protocol, British Society of Gastroenterology Endoscopy Committee guidelines and the UK Comparative Audit of AUGIB and the Use of Blood.

Results: 53 patients were identified, of which 41 case notes were available. Mean (range) age of the patients was 75.8 (45-92) years. 56% had pre-existing cardiorespiratory comorbidity and 63% were taking anti-inflammatory drugs. Pre-operative Rockall score was >or=7 in 46% and ASA score was >or=3 in 65% of patients. 56% of operations were performed by the registrar, compared with 20% reported nationally. All cases after 2004 were performed by the consultant. No operations were performed after midnight beyond 1999. 23 (56%) patients suffered post-operative complications compared with 55% reported nationally; cardiorespiratory (n = 16), wound infection (n = 7) and rebleed (n = 6). 37% required intensive care support and median length of hospital stay was 13 days. In-hospital mortality rate was 10%, compared with 30% reported nationally and this increased with rising Rockall, Blatchford, APACHE-2, P-POSSUM and Charlson scores.

Conclusions: These findings highlight the high rate of morbidity and mortality associated with surgical treatment for AUGIB. The small volume of cases and reduction in registrar operating raises training issues. An integrated approach with greater use of interventional radiology is likely to play a greater role in the future.