Risk of postoperative upper gastrointestinal tract hemorrhage in patients with active peptic ulcer disease undergoing nonulcer surgery

Ratta, Ralph K. Della; Corapi, M. J.; Horowitz, B R; Calio, A J

doi:10.1001/archinte.153.18.2141

Cited by 5 publications

(2 citation statements)

References 6 publications

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“…Long term use of steroid drugs are also relevant in patients after cardiac transplantation [30]. There are conflicting opinions about the role of pre-existing peptic ulcer disease as a cause of post operative gastric ulcer and hemorrhage [31,32].…”

Section:  Physiological Stressmentioning

confidence: 99%

Stress gastric ulcer after cardiac surgery: Pathogenesis risk factors and medical management

Houssa¹,

Atmani²,

Nya³

et al. 2013

WJCD

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Stress ulcer lesions of upper gastrointestinal tract are well recognized in patients undergoing open cardiac surgery. Gastrointestinal bleeding following cardiac surgery is infrequent with significant morbidity and mortality. The pathogenesis of mucosal lesions and subsequent haemorrhage is complex and multifactorial. The diagnosis as well as the treatment of this complication remains a challenge for surgeons. Identifying the source of bleeding can be difficult. Despite of the successful control of haemorrhage using various combinations of endoscopic and pharmacological therapies, the mortality rate remains unchanged. Benefit of routine stress ulcer prophylaxis remains controversial.

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Section:  Physiological Stressmentioning

confidence: 99%

Stress gastric ulcer after cardiac surgery: Pathogenesis risk factors and medical management

Houssa¹,

Atmani²,

Nya³

et al. 2013

WJCD

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“…Much of the information about risk is derived from the Determining a preoperative international normalised ratio threshold safe for hip fracture surgery general and cardiac surgery literature. 7,8 Preoperative INR thresholds have been evaluated for elective primary total knee and hip arthroplasty, 9,10 but only recently in hip fracture surgery. Varady et al 11 showed that an INR > 1.5 could serve as a marker of increased complications.…”

Section: Introductionmentioning

confidence: 99%

Determining a preoperative international normalised ratio threshold safe for hip fracture surgery

et al. 2023

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Introduction: The purpose of this study was first, to assess the relationship between preoperative INR (international normalised ratio) and postoperative complication rates in patients with a hip fracture, and second, to establish a threshold for INR below which the risk of complications is comparable to those in patients with a normal INR. Methods: We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program and found 35,910 cases who had undergone surgery for a hip fracture between 2012 and 2018. Cases were stratified into 4 groups based on their preoperative INR levels: <1.4; ⩾1.4 and <1.6; ⩾1.6 and <1.8 and ⩾1.8. These cohorts were assessed for differences in preoperative factors, intraoperative factors, and postoperative course. Multivariate logistic regression was used to assess the risk of transfusion, 30-day mortality, cardiac complications, and wound complications adjusting for all preoperative and intraoperative factors. Results: Of the 35,910 cases, 33,484 (93.2%) had a preoperative INR < 1.4; 867 (2.4%) an INR ⩾1.4 and <1.6; 865 (2.4%) an INR ⩾ 1.6 and <1.8 and 692 (1.9%) an INR ⩾ 1.8. A preoperative INR ⩾ 1.8 was independently associated with an increased risk of bleeding requiring transfusion. A preoperative INR ⩾ 1.6 was associated with an increased risk of mortality. Conclusions: We found that an INR of <1.6 is a safe value for patients who are to undergo surgery for a hip fracture. Below this value, patients avoid an increased risk of both transfusion and 30-day mortality seen with higher INR values. These findings may allow adjustment of preoperative protocols and improve the outcome of hip fracture surgery in this group of patients.

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Upper gastrointestinal haemorrhage following cardiac surgery

Jayaprakash

McGrath²,

McCullagh³

et al. 2004

European Journal of Gastroenterology & Hepatology

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Risk of postoperative upper gastrointestinal tract hemorrhage in patients with active peptic ulcer disease undergoing nonulcer surgery

Cited by 5 publications

References 6 publications

Stress gastric ulcer after cardiac surgery: Pathogenesis risk factors and medical management

Stress gastric ulcer after cardiac surgery: Pathogenesis risk factors and medical management

Determining a preoperative international normalised ratio threshold safe for hip fracture surgery

Upper gastrointestinal haemorrhage following cardiac surgery

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