Association of endoscopic intervention with mortality in gastrointestinal bleeding after open-heart surgery: a propensity-score cohort study.

Abstract

Postoperative gastrointestinal bleeding (GIB) after open-heart surgery is associated with increased mortality, yet the prognostic impact of endoscopic intervention remains uncertain. 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. 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). 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.