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Association of endoscopic intervention with mortality in gastrointestinal bleeding after open-heart surgery: a
Hailin Du1, Yamei Sun1, Guoyan Bai2
1Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Endoscopic intervention for postoperative gastrointestinal bleeding after open-heart surgery was linked to significantly lower 30-day and 1-year mortality rates. This study suggests potential benefits of endoscopy, though further prospective research is needed.
Area of Science:
- Cardiology
- Gastroenterology
- Surgical Outcomes
Background:
- Postoperative gastrointestinal bleeding (GIB) following open-heart surgery is a serious complication associated with increased mortality.
- The prognostic impact and effectiveness of endoscopic interventions for managing GIB in this patient population remain uncertain.
Purpose of the Study:
- To evaluate the association between endoscopic intervention and mortality outcomes in patients experiencing GIB after open-heart surgery.
- To assess the impact of endoscopy on major postbleeding complications and hospital length of stay.
Main Methods:
- A single-center retrospective cohort study included adult patients who developed GIB within 30 days of open-heart surgery (2017-2024).
- Propensity-score matching was employed to balance baseline characteristics between patients who received endoscopic intervention and those who did not.
- Outcomes included 30-day and 1-year all-cause mortality, major in-hospital complications, and hospital length of stay.
Main Results:
- The endoscopy group showed significantly lower 30-day mortality (26.5% vs. 49.8%; HR 0.54) and 1-year mortality (HR 0.52) compared to the non-endoscopy group.
- No statistically significant differences were found in major postbleeding complications (OR 1.86) or prolonged hospital stay (GMR 1.17).
- Endoscopic intervention was associated with a higher cumulative incidence of discharge, considering death as a competing event (SHR 1.53).
Conclusions:
- Endoscopic intervention for postoperative GIB after open-heart surgery appears associated with reduced short-term and long-term mortality.
- While endoscopy did not significantly impact major complications or length of stay, it was linked to a higher likelihood of discharge.
- These findings are hypothesis-generating, necessitating future prospective studies to confirm the benefits of endoscopic management in this high-risk group.
Introduction:
Postoperative gastrointestinal bleeding (GIB) after open-heart surgery is associated with increased mortality, yet the prognostic impact of endoscopic intervention remains uncertain.
Methods:
We conducted a single-center retrospective cohort study of adults who developed GIB within 30 days after open-heart surgery (2017-2024). Patients were categorized into endoscopy and non-endoscopy groups, and propensity-score full matching was used to balance baseline covariates. The primary outcome was 30-day all-cause mortality; secondary outcomes were 1-year all-cause mortality, major postbleeding in-hospital complications (including acute myocardial infarction, acute respiratory distress syndrome, and other serious postoperative events), and postbleeding hospital length of stay.
Results:
Of 712 patients screened, 271 were included (endoscopy n = 68; non-endoscopy n = 203). After balancing baseline covariates, lower 30-day mortality was observed in the endoscopy group compared with the non-endoscopy group (adjusted mortality 26.5% vs. 49.8%; hazard ratio [HR] 0.54; 95% CI 0.32-0.91; P = 0.021, using a time-dependent Cox model). A similar pattern was observed at 1 year (HR 0.52; 95% CI 0.32-0.84; P = 0.007). No statistically significant difference was observed in major postbleeding in-hospital complications (odds ratio 1.86; 95% CI 0.94-3.68; P = 0.082, with residual uncertainty regarding potential harm) or prolonged length of stay (geometric mean ratio 1.17; 95% CI 0.99-1.39; P = 0.070). Endoscopy was associated with a higher cumulative incidence of discharge, accounting for death as a competing event (subdistribution HR 1.53; 95% CI 1.14-2.07; P = 0.005).
Discussion:
Among clinically eligible patients with postoperative GIB after open-heart surgery, lower 30-day and 1-year mortality rates were observed in those undergoing endoscopic intervention, whereas no statistically significant differences were observed in major postbleeding in-hospital complications or hospital length of stay. Given the retrospective nature of the study, these results should be considered hypothesis-generating rather than confirmatory, serving as a basis for future prospective investigations.
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