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

Abstract

Sergiu Marian Cazacu,1 Mircea Parscoveanu,2,* Ion Rogoveanu,1,* Alexandru Goganau,2 Alexandru Vieru,3 Emil Moraru,2 Dan Cartu2 1Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania; 2Surgery Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania; 3Doctoral School, University of Medicine and Pharmacy of Craiova, Emergency County Hospital Craiova, Craiova, Romania*These authors have a contribution equal to the principal authorCorrespondence: Emil Moraru; Mircea Parscoveanu, Email [email protected]; [email protected]; [email protected]; [email protected]: 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: upper gastrointestinal bleeding, peptic ulcer bleeding, endoscopy, emergency surgery

Keywords

• upper gastrointestinal bleeding
• peptic ulcer bleeding
• endoscopy
• emergency surgery