September 27, 1993

Risk of Postoperative Upper Gastrointestinal Tract Hemorrhage in Patients With Active Peptic Ulcer Disease Undergoing Nonulcer Surgery

Author Affiliations

From the Division of General Internal Medicine, Winthrop-University Hospital, Mineola, NY, and Department of Medicine, State University of New York at Stony Brook School of Medicine.

Arch Intern Med. 1993;153(18):2141-2144. doi:10.1001/archinte.1993.00410180095011

Background:  Although peptic ulcer disease (PUD) is common in adults, the risk of bleeding from an active ulcer after nonulcer surgery is poorly defined in the literature. The objectives of this study were to define the risk of postoperative upper gastrointestinal (UGI) tract hemorrhage in patients with active PUD and to identify risk factors that predict bleeding.

Methods:  This case-control study was conducted at a suburban community teaching hospital. Sixty patients with active PUD at the time of nonulcer surgery were identified and compared with a control group of 120 patients without PUD. All charts were reviewed for the presence of coagulopathy, antiplatelet and anticoagulant drug use, preoperative and postoperative UGI tract bleeding, and perioperative medical therapy for PUD.

Results:  Cases and controls were similar in age, length of stay, number of procedures, type of surgery, anticoagulant use, and presence of coagulopathy. Most patients had general surgery; none had neurosurgery, and few had cardiac surgery. Patients with PUD had a greater number of major diagnoses (P<.02), rate of preoperative UGI tract bleeding (P<.001), and use of perioperative antiulcer medications (P<.02). There was no difference in the rate of postoperative UGI tract bleeding between the two groups (P=.63; odds ratio, 1.3; 95% confidence interval, 1.21 to 1.41). There were no patient characteristics that predicted postoperative UGI tract bleeding. While 10% of patients with PUD experienced postoperative UGI tract bleeding, only one required blood transfusion; in the majority, the bleeding was clinically unimportant.

Conclusion:  For patients with PUD similar to this study group, nonulcer surgery need not be deferred to allow for peptic ulcer healing.(Arch Intern Med. 1993;153:2141-2144)