Abstract:
Background and Aim: With the introduction of H2 receptor antagonists and proton pump
inhibitors, the incidence of elective surgery for peptic ulcer (PU) diseases has decreased,
although complications of PU such as perforation and bleeding have remained fairly
constant. The purpose of this study was to identify the risk factors that predict morbidity
and mortality in patients with perforated PU.
Methods: The records of 269 patients who were operated on for perforated PU were
reviewed retrospectively. The following factors were analyzed in terms of morbidity and
mortality: age >65 years; gender; associated medical illness; chronic ingestion of nonsteroidal
anti-inflammatory drugs, aspirin, corticosteroids or immunosuppressants; alcohol
ingestion and smoking habits; American Society of Anesthesiologist (ASA) status; season;
delayed operation; site of ulcer perforation; and shock on admission and type of operation.
Results: There were 30 female (11.16%) and 239 male (88.84%) patients. Seventy-one
(26.4%) patients had associated diseases. Simple closure was performed in 257 (95.5%)
patients; 12 patients (4.5%) underwent definitive operations. A total of 108 postoperative
complications were present in 65 (24.2%) patients. Twenty-three patients died (8.55%).
Multivariate analysis showed that only age, ASA score, treatment delay, presence of shock
and definitive operation were independent predictors of mortality. Significant risk factors
that led to morbidity were ASA status, time of surgery, season, presence of shock and type
of surgery. There was a significant difference concerning morbidity and mortality between
simple closure of the perforation and definitive surgery.
Conclusions: Age, delayed surgery, presence of shock, ASA risk and definitive surgery
are factors significantly associated with fatal outcomes in patients undergoing emergency
surgery for perforated PU. Therefore, proper resuscitation from shock, improving ASA
grade, decreasing delay and reserving definitive surgery for selected patients is needed to
improve overall results.
