Need of Emergency Surgery in Elderly Patients with Upper Gastrointestinal Bleeding: Survival Analysis during 2009–2015

Abstract

Background/Aims: The role of emergency surgery is decreasing in the treatment of patients with upper gastrointestinal bleeding (UGIB). We investigated the need of urgent surgery and outcome of elderly UGIB patients who often have cardiovascular comorbidities with antithrombotic medication. Methods: All consecutive adult patients who received emergency treatment for suspected gastrointestinal bleeding between January 2009 and December 2011 were registered in an electronic database (n = 1,643). A total of 569 patients with a first-time UGIB were identified, of whom 282 were ≥70 years old. Age-specific incidence rates, risk factors for bleeding and need of endoscopic or emergency surgery were studied. Long-term mortality was compared to age-adjusted control subjects (n = 569) without bleeding. Results: The age-specific incidence of UGIB increased from 156 to 401 cases per 100,000 inhabitants from age 60–69 to 80–89 years, respectively. Cardiovascular comorbidities and antithrombotic therapies (acetosalicylic acid 51 vs. 27%; warfarins 25 vs. 11%) related to UGIB were more common in patients over than under 70 years of age (p < 0.0001). Early endoscopic therapy was successful in over 95% of patients, whereas emergency surgery was needed only in 6 (2%) patients ≥70 years old. Hospital mortality (7.8%) was acceptable in these patients, but the 5-year mortality (40%) was significantly higher than in controls (20%, p < 0.001). Conclusion: Today, emergency surgery is seldom needed in the patients with UGIB. In comparison to the age-matched control population, long-term survival was significantly lower after UGIB in the elderly.

Long-Term Outcomes following Acute Upper Gastrointestinal Bleeding Remain Poor: A Single-Center Comparison over Two Distinct Time Periods within the Last 15 Years in Finland

“…Although short-term mortality is relatively well documented, there remains a paucity of research examining the long-term outcomes associated with AUGIB [7–9]. Understanding the long-term prognosis and consequences of AUGIB is crucial for developing comprehensive management strategies.…”

“…Although short-term mortality is relatively well documented, there remains a paucity of research examining the long-term outcomes associated with AUGIB [7][8][9].…”

Decreased Serum Monocyte Chemoattractant Protein-1 (MCP-1) Expression in Patients with Upper Gastrointestinal Bleeding

“…In addition, adequate fluid resuscitation is required to prevent circulatory failure. However, the gastrointestinal bleeding and the large amount of liquid infusion in follow-up treatment can easily lead to abnormal metabolism such as anemia, water-electrolyte imbalance, and dyslipidemia [ 3 ]. There is no available literature that evaluates the correlations of UGIB with dyslipidemia.…”