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. 2024 Dec 13:17:6171-6184.
doi: 10.2147/IJGM.S496966. eCollection 2024.

Trends for Admission, Mortality and Emergency Surgery in Upper Gastrointestinal Bleeding: A Study of Eight Years of Admissions in a Tertiary Care Hospital

Sergiu Marian Cazacu  1 , Mircea Parscoveanu #  2 , Ion Rogoveanu #  1 , Alexandru Goganau  2 , Alexandru Vieru  3 , Emil Moraru  2 , Dan Cartu  2
Affiliations

Trends for Admission, Mortality and Emergency Surgery in Upper Gastrointestinal Bleeding: A Study of Eight Years of Admissions in a Tertiary Care Hospital

Sergiu Marian Cazacu et al. Int J Gen Med. .

Abstract

Introduction: Most studies have shown a declining incidence of upper gastrointestinal bleeding (UGIB) in recent years. Data regarding mortality were controversial; in non-variceal bleeding, the increasing age of the population, increased use of anti-thrombotic and anticoagulant therapy in patients with cardiovascular diseases, and the use of non-steroidal anti-inflammatory drugs are counterbalanced by the progress in endoscopic therapy with stable mortality.

Material and method: We performed a retrospective, cross-sectional study that included patients admitted with UGIB in Clinical Emergency Hospital Craiova during 2013-2020.

Results: 3571 patients with UGIB were selected; a trend toward increased admission for UGIB from 2013 to 2019 was noted, with a significant decrease in 2020. Non-variceal bleeding remains the most frequent form, with a slight increase in variceal bleeding, of Mallory-Weiss syndrome and angiodysplasia, and a 3-fold decrease for unknown etiology bleeding (with no endoscopy performed) during the 2017-2020 period as compared to 2013-2016. There was a trend toward decreased mortality, with lower mortality in 2017-2020 (12.83%) compared to 2013-2016 (17.41%). The mortality for variceal bleeding and peptic ulcer bleeding has declined, but mortality for non-variceal bleeding has slightly increased during 2013-2020. Mortality has decreased in admissions during regular hours/after hours and weekdays/weekends, but the difference (off-hours and weekend effects) had increased. The percentage of endoscopies performed in the first 24 hours after admission and the rate of therapeutic endoscopy increased during 2017-2020; the median time between admission and endoscopy was 17.0 hours during 2017-2020 and 59.1 hours during 2013-2016. The proportion of patients who needed emergency surgery for uncontrolled bleeding has significantly declined since 2013-2015, with an average value of 1% in the last 5 years of the study.

Conclusion: Increased admissions for UGIB, with lower mortality, especially for peptic ulcer bleeding and variceal bleeding were noted; higher percentages of therapeutic endoscopies and endoscopies performed during the first 24 hours after admission were also recorded.

Keywords: emergency surgery; endoscopy; peptic ulcer bleeding; upper gastrointestinal bleeding.

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Conflict of interest statement

The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
Admissions for UGIB (2013–2020).
Figure 2
Figure 2
In-hospital mortality for UGIB (2013–2020).
Figure 3
Figure 3
The mean value of pre-endoscopic Baylor bleeding score in UGIB (2013–2020).
Figure 4
Figure 4
The mean value of after-endoscopic Baylor bleeding score in UGIB (2013–2020).
Figure 5
Figure 5
Case-fatality rate for variceal bleeding (2013–2020).
Figure 6
Figure 6
Case-fatality rate for peptic ulcer bleeding (2013–2020).
Figure 7
Figure 7
Case-fatality rate for non-variceal UGIB (2013–2020).
Figure 8
Figure 8
Case-fatality rate for UGIB with no endoscopy (2013–2020).
Figure 9
Figure 9
Mortality in UGIB adjusted by admission during regular hours/after hours (2013–2020).
Figure 10
Figure 10
Mortality in UGIB adjusted by admission during weekdays/weekends (2013–2020).
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