Kim Sang Hyuck, Han Kyungdo, Kang Gunseog, Lee Seung Woo, Park Chi-Min, Cho Jongho, Choi Jung Won, Park Se Jun, Kang Minyong, Kim Tae Jun, Hong Seo-Hee, Kwon Yong-Chol, Park Junhee, Shin Dongwook
Department of Family Medicine, Bumin Hospital, Seoul 07590, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea.
J Pers Med. 2021 Nov 18;11(11):1222. doi: 10.3390/jpm11111222.
Postoperative gastrointestinal bleeding (PGIB) is a serious complication with expensive medical costs and a high mortality rate. This study aims to analyze the incidence of PGIB and its associated factors, including its relationship with postoperative analgesic use. Patients aged ≥20 years who received various kinds of surgery from 2013 to 2017 were included ( = 1,319,807). PGIB was defined by admission with ICD-10 codes of gastrointestinal bleeding plus transfusion within 2 months after surgery. A total of 3505 (0.27%) subjects had PGIB, and the incidence was much higher for those who underwent major gastrointestinal and major cardiovascular surgery (1.9% for both), followed by major head and neck (0.7%), major genitourinary (0.5%), and orthopedic surgery (0.45%). On multivariate analysis, older age, male sex, lower income, comorbidities, peptic ulcer disease, and congestive heart failure were associated with a higher risk of gastrointestinal bleeding. Among analgesics, steroid use was associated with increased postoperative bleeding risk (adjusted OR: 1.36, 95% CI: 1.25-1.48). Acetaminophen/nonsteroidal anti-inflammatory drugs, cyclooxygenase 2 inhibitors, anticonvulsants, antidepressants, and opioids were not associated with increased risk. PGIB is considerable for major surgeries, and its risk should be considered, especially for patients with older age and comorbidities and use of steroids.
术后胃肠道出血（PGIB）是一种严重的并发症，医疗成本高昂且死亡率高。本研究旨在分析PGIB的发生率及其相关因素，包括其与术后镇痛药物使用的关系。纳入了2013年至2017年接受各种手术的年龄≥20岁的患者（n = 1,319,807）。PGIB的定义为术后2个月内因胃肠道出血的ICD-10编码入院并接受输血。共有3505名（0.27%）受试者发生PGIB，接受重大胃肠道和重大心血管手术的患者发生率更高（两者均为1.9%），其次是重大头颈手术（0.7%）、重大泌尿生殖手术（0.5%）和骨科手术（0.45%）。多因素分析显示，年龄较大、男性、收入较低、合并症、消化性溃疡疾病和充血性心力衰竭与胃肠道出血风险较高相关。在镇痛药中，使用类固醇与术后出血风险增加相关（调整后的OR：1.36，95%CI：1.25 - 1.48）。对乙酰氨基酚/非甾体抗炎药、环氧化酶2抑制剂、抗惊厥药、抗抑郁药和阿片类药物与风险增加无关。PGIB在重大手术中较为常见，应考虑其风险，尤其是对于年龄较大、有合并症且使用类固醇的患者。
