Authors : Gholipoor Changeaz , Shalchi A. Rosita and Abbasi Mehrshad
Abstract: Surgical management of certain cases with Upper Gastrointestinal Bleedings (UGIB) is inevitable. Several studies suggested that the mortality and morbidity of these procedures in emergency settings is unfavorably high. This study was conducted to evaluate the outcome of patients who underwent emergency surgery for UGIB in capital city of a northeastern province of Iran. A retrospective cross sectional design was settled to explore the medical information of general surgery wards and intensive care unit of two tertiary teaching university hospitals. Out of 1001 patients admitted with the diagnosis of UGIB, the data on the risk factors and outcomes of the operation of the 102 patients who were operated on to control UGIB from March 2002 to December 2005 were collected. Out of 102 (15 females and 87 males) patients who underwent surgery, 27 subjects did not survive. Peptic ulcer was the most common etiology of bleeding and hematemesis was the most common presenting manifestation of the condition. Age over 60, shock during hospitalization, coexisting disease, in-hospital bleeding and transfusion requirement more than 6 units of packed cells were accompanied by increased operative mortality. Arrangement of suture ligation, vagotomy and pyloroplasty had the least rates of relapsing bleeding (12.6%) and mortality (24.1%). Antrectomy and vagotomy had the highest mortality (45.5%) and subtotal gastrectomy had highest relapsing bleeding (20%). Mortality rate of operation conducted by non-attending surgeons was insignificantly higher than that of operations conducted by attending surgeons (29.3% Vs. 18.5%; p>0.05). Operative mortality in 44.1% of patients was potentially avoidable. High operative mortality rate found in this study was associated with older age, presence of co existing disease, in-hospital re-bleeding and shock and outsized transfusion requirement. Supervision of attending surgeons may reduce the mortality rate of emergency surgeries of UGIB.
Gholipoor Changeaz , Shalchi A. Rosita and Abbasi Mehrshad , 2008. Outcomes of Emergency Surgical Management of Upper Gastrointestinal Bleedings and its Correlates in Two Referral Hospitals at Tabriz. Surgery Journal, 3: 82-86.