A recent UK audit on acute upper gastrointestinal bleeding shows improved patient outcomes despite higher comorbidities and inappropriate transfusion practices.

• Comorbidities rose from 50% to 67%, with 15% of patients having cirrhosis.
• Transfusion rates increased to 50%, and 24% of early transfusions were deemed inappropriate, linked to higher adjusted mortality at hemoglobin thresholds above 80 g/l.
• Lower rebleeding rates (9.7% vs 13.3%) and reduced in-hospital mortality (8.8% vs 10.0%) were observed, indicating better management strategies.

Surgeons should prioritize risk stratification and adopt restrictive transfusion practices to enhance patient safety.