Is There a High Risk for GI Bleeding Complications in Patients Undergoing Abdominal Surgery?

Abstract

Introduction: Gastrointestinal bleeding (GIB) can cause life-threatening situations. Here, endoscopy is the first-line diagnostic and therapeutic mode in patients with GIB among further therapeutic approaches such as embolization or medical treatment. Although GIB is considered the most common indication for emergency endoscopy in clinical practice, data on GIB in abdominal surgical patients are still scarce. Patients and methods: For the present study, all emergency endoscopies performed on hospitalized abdominal surgical patients over a 2-year period (1 July 2017–30 June2019) were retrospectively analyzed. Primary endpoint was 30-day mortality. Secondary endpoints were length of hospital stay, cause of bleeding, and therapeutic success of endoscopic intervention. Results: During the study period, bleeding events with an indication for emergency endoscopy occurred in 2.0% (129/6455) of all surgical inhouse patients, of whom 83.7% (n = 108) underwent a surgical procedure. In relation to the total number of respective surgical procedures during the study period, the bleeding incidence was 8.9% after hepatobiliary surgery, 7.7% after resections in the upper gastrointestinal tract, and 1.1% after colonic resections. Signs of active or past bleeding in the anastomosis area were detected in ten patients (6.9%). The overall 30-day mortality was 7.75%. Conclusions: The incidence of relevant gastrointestinal bleeding events in visceral surgical inpatients was overall rare. However, our data call for critical peri-operative vigilance for bleeding events and underscore the importance of interdisciplinary emergency algorithms.

Surgery and Reason: The End of History and the Last Surgeon

“…Based on increasing evidence favoring the use of multiple arterial conduits in patients undergoing CABG [11], a "Hegelian" circle, based on the superiority of the MAG approach, is about to close, and a new one is about to open, which will examine different strategies in conduits harvesting, treatment protocols on the extent of target vessel stenosis for radial artery conduits, along with post-discharge treatment protocols. The present Special Issue includes several articles that aim to answer important debates on different perioperative treatment pathways [12][13][14][15][16][17][18]. Two of them [14,15] validate risk-stratification tools, thus providing a necessary insight into preoperative planning and patient counseling while enhancing the shared decision-making process.…”

“…Dr. Richard Prager is a characteristic world-historical individual in the field of QI in cardiothoracic surgery. From the very beginning of his efforts to establish a QI program in the State of Michigan, Dr. Prager faced certain great challenges, such as a) gathering all cardiothoracic surgeons of the State around a common table to discuss their outcomes and designing QI initiatives, The present Special Issue includes several articles that aim to answer important debates on different perioperative treatment pathways [12][13][14][15][16][17][18]. Two of them [14,15] validate risk-stratification tools, thus providing a necessary insight into preoperative planning and patient counseling while enhancing the shared decision-making process.…”