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Upper gastrointestinal haemorrhage following cardiac surgery: a comparative study with vascular surgery patients from
Anthoor Jayaprakash1, Christine McGrath, Emily McCullagh
1Department of Gastroenterology, Bristol Royal Infirmary, UK. jaypy@hotmail.com
Insights
Upper gastrointestinal haemorrhage (UGH) is rare after cardiac or vascular surgery, occurring in less than 1.1% of patients. However, UGH significantly increases mortality, underscoring the need for prompt intervention.
Area of Science:
- Gastroenterology
- Cardiovascular Surgery
- Surgical Complications
Background:
- Upper gastrointestinal haemorrhage (UGH) is a potential complication following major surgery.
- Understanding the incidence and outcomes of UGH in cardiac versus vascular surgery patients is crucial for risk stratification and management.
Purpose of the Study:
- To compare the frequency and outcomes of post-operative upper gastrointestinal haemorrhage (UGH) in patients who underwent cardiac surgery versus those who underwent vascular surgery.
Main Methods:
- A retrospective review of patients undergoing cardiac or vascular surgery between January 1999 and December 2000.
- Inclusion criteria: post-operative haematemesis and/or melaena.
Main Results:
- The incidence of UGH was 0.9% in cardiac surgery patients and 1.1% in vascular surgery patients.
- 90% of cardiac and 43% of vascular UGH patients were on antiplatelet or anticoagulant therapy.
- Mortality for cardiac surgery patients with UGH was 15%, significantly higher than the overall cardiac surgery mortality (2.3%).
Conclusions:
- Post-operative UGH rates are similar and low in both cardiac and vascular surgery patients.
- UGH is associated with a substantial increase in mortality after primary surgery.
- Early surgical intervention for UGH may be life-saving in critically ill patients.
Objective:
To compare the frequency and outcome of upper gastrointestinal haemorrhage (UGH) patients who had undergone cardiac surgery with a control group of vascular surgery patients.
Patients:
Patients who had undergone cardiac or vascular surgery from January 1999 to December 2000 were identified from departmental records. The inclusion criteria used were haematemesis and/or melaena in the post-operative period.
Results:
Only 20 of the 2274 (0.9%) cardiac operations were complicated by UGH compared to eight of 708 (1.1%) vascular operations. Among those with UGH, 90% of the cardiac and 43% of the vascular patients were taking aspirin, warfarin or both. The mean interval between surgery and the UGH was 9.6 days (range 1-30) for the cardiac and 6 days (range 0-15) for the vascular patients. Duodenal and gastric ulcers were the most common cause of UGH (60%) in the cardiac group. Despite endoscopic intervention, more than one third of ulcer associated haemorrhages required surgical over-sewing, but none of the patients who had surgery died. The overall mortality on the cardiac surgery patients who experienced UGH was 15%, significantly higher than the 2.3% for the whole cardiac surgery group during the study period (P = 0.00075, OR = 8, 95% confidence interval 2.3-28). However, even this mortality is less than that of general inpatients who suffer UGH (33%).
Conclusions:
Cardiac and vascular surgical patients have similar low post-operative rate of UGH. Post-operative UGH is associated with increased mortality after primary surgery. Early surgical intervention appears to be life saving in those patients who are too ill to compensate for the haemodynamic disturbance of untreated UGH.
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