Upper GI bleeding in rural Australia: general surgery still alive and well!

Sabat, Nestor, McSweeney, William, Konno, Takuma, Gilberd, Matthew, Molloy, Charles, and Pretorius, Casper (2023) Upper GI bleeding in rural Australia: general surgery still alive and well! ANZ Journal of Surgery, 93 (6). pp. 1577-1582.

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View at Publisher Website: https://doi.org/10.1111/ans.18454
 
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Abstract

Background: The complex and critically unwell upper gastrointestinal bleeding (UGIB) patient is a common emergency presentation in Australia. Managed medically and endoscopically by rural general surgeons in rural and remote Australian hospitals which lack a gastroenterology service, this can be ameliorated by clear evidence-based guidelines.

Methods: A single-centre retrospective review of adult patients who underwent emergency gastroscopy for UGIB at the Mackay Base Hospital, January 2019 to January 2022. Detailed patient data from the assessment, resuscitation, time to endoscopy, endoscopic intervention, and outcomes were compared against key international gastroenterology society safety and quality standards for UGIB.

Results: Two hundred patients had a comprehensive initial assessment and resuscitation with PRBC (39%), anticoagulation reversal (18%), pantoprazole infusion (81%), tranexamic acid (10.50%) and octreotide (16.50%). Risk scores were calculated retrospectively as none were documented. Time-to-endoscopy targets were achieved in over 70% of variceal or non-variceal UGIB patients. Bleeding was found in 59.50% of patients but 63% of patients did not require a manoeuvre to stop the bleeding. Post-operative complications were scarce.

Conclusion: This study reflects on the need for a local multidisciplinary protocol to help expedite the current high-quality healthcare delivered by rural general surgeons in managing patients with UGIB. Implementing risk assessment scores would shorten the time to endoscopy in the initial assessment Guidelines would optimize resuscitation ensuring appropriate replacement, medication administration, anticoagulation reversal, and preventing unnecessary therapy. Despite these nuisances, the time to endoscopy, endoscopic intervention, and patient outcomes were largely in line with international quality assurance and safety targets.

Item ID: 79076
Item Type: Article (Research - C1)
ISSN: 1445-2197
Keywords: non-variceal bleed, quality assurance, upper gastrointestinal bleed, variceal bleed
Copyright Information: © 2023 Royal Australasian College of Surgeons.
Date Deposited: 03 Jan 2024 22:09
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320226 Surgery @ 50%
42 HEALTH SCIENCES > 4203 Health services and systems > 420321 Rural and remote health services @ 50%
SEO Codes: 20 HEALTH > 2003 Provision of health and support services > 200311 Urgent and critical care, and emergency medicine @ 50%
20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200508 Rural and remote area health @ 50%
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