Background: Surgical treatment of acute bleeding duodenal ulcers involves pyloroplasty and oversew of the bleeding vessel. In the era of H. pylori treatment, the role of vagotomy in this setting is debatable. To determine the current surgical treatment of acute bleeding duodenal ulcers and evaluate the use of vagotomy in this setting, national outcomes for acute bleeding duodenal ulcers were examined from 1999 to 2003. Methods: Data were analyzed from the Nationwide Inpatient Sample (NIS) from the year 1999 to 2003. International Classification of Disease (ICD-9) codes were used for diagnostic and procedure codes to identify patients with an acute duodenal ulcer bleed and patients undergoing simple oversew of the bleeding ulcer. Appropriate sampling weights are applied for national estimates. Multiple linear and logistic regression analyses are used to examine predictive variables for the addition of a vagotomy with oversew of a bleeding ulcer. Results: The total number of bleeding duodenal ulcers did not change between the years 1999 to 2003 (table). 8.1% of vagotomies performed during oversew of an acute bleeding ulcer are highly selective while 91.9% are truncal or not otherwise specified. Using logistic regression analysis for predictors of vagotomy in acute bleeding duodenal ulcers, a high co-morbidity index (odds ratio (OR), 0.60, p 0.017), operation performed in the South (OR 0.50, p 0.00) and operation performed in the West (OR 0.68, p 0.034) were predictive of not undergoing vagotomy as part of surgery for a bleeding duodenal ulcer. Patients with higher household income were less likely to undergo vagotomy by univariate analysis (OR 0.85, p 0.03). Age, race, acuity of admission, gender, hospital teaching status, rural or urban location of the hospital and type of insurance were not significant predictors for vagotomy in either univariate or multivariate models. Conclusions: The current incidence of surgical vagotomy when performing oversew of an acute bleeding duodenal ulcer is approximately 46% and remained relatively constant over the five year study period. Patients with greater numbers of co-morbidities and higher household income are less likely to undergo vagotomy. Surgeons in the South and West perform fewer vagotomies than their counterparts in the Midwest and the Northeast.