Factors influencing mortality in patients with bleeding ulcer. Review of 7 years' experience preceding therapeutic endoscopy.

Abstract

Over a seven-year period 369 patients with a median age of 67 years were admitted with bleeding peptic ulcer and 41% of the patients required emergency surgery. In 37 low risk patients (24%), defined as patients younger than 70 years without a complicating disease, the mortality rate following emergency surgery was 11% compared to 36% in 118 poor-risk patients (p less than 0.005). A preexisting complicating illness, postoperative complications, and absent history of dyspepsia were calculated to be the three most important factors determining fatal outcome. Age, onset of hemorrhage during hospitalization or prior to admission, previous ulcer surgery, previous bleeds, preoperative endoscopy, site of the ulcer, timing of surgery, and transfusion requirements had comparatively less bearing on the outcome. Hematocrit exceeding 37 in the postoperative period, however, was associated with a significantly increased risk of cardiopulmonary insufficiency. Though surgery controls life-threatening hemorrhage, it is badly tolerated in the many poor-risk patients, and an evaluation of other efficient methods carrying a lower risk of lethal complications seems justified.