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Delay in Source Control in Perforated Peptic Ulcer Leads to 6% Increased Risk of Death Per Hour: A Nationwide Cohort Study

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Abstract

Background

Delay to theatre for patients with intra-abdominal sepsis is cited as a particular risk factor for death. Our aim was to evaluate the potential relationship between hourly delay from admission to surgery and post-operative mortality in patients with perforated peptic ulcer (PPU).

Methods

All patients entered in the National Emergency Laparotomy Audit who had an emergency laparotomy for PPU within 24 h of admission from December 2013 to November 2017 were included. Time to theatre from admission was modelled as a continuous variable in hours. Outcome was 90-day mortality. Logistic regression adjusting for confounding factors was performed.

Results

3809 patients were included, and 90-day mortality rate was 10.61%. Median time to theatre was 7.5 h (IQR 5–11.6 h). The odds of death increased with time to operation once adjustment for confounding variables was performed (per hour after admission adjusted OR 1.04 95% CI 1.02–1.07). In patients who were physiologically shocked (N = 334), there was an increase of 6% in risk-adjusted odds of mortality for every hour Em Lap was delayed after admission (OR 1.06 95% CI 1.01–1.11).

Conclusion

Hourly delay to theatre in patients with PPU is independently associated with risk of death by 90 days. Therefore, we suggest that surgical source control should occur as soon as possible after admission regardless of time of day.

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Acknowledgements

The authors wish to acknowledge the work of all past and present members of the National Emergency Laparotomy Audit Project team who have been involved in the running and progression of the Audit and the NHS staff who have submitted data to NELA over the last 4 years.

Author information

Authors and Affiliations

  1. Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK

    H. Boyd-Carson, B. Doleman, J. P. Williams, G. M. Tierney & J. N. Lund

  2. National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK

    H. Boyd-Carson, D. Cromwell, S. Lockwood, G. M. Tierney & I. D. Anderson

  3. Division of Medical Sciences and Graduate Entry Medicine, Department of Surgery, University of Nottingham, Nottingham, UK

    H. Boyd-Carson, B. Doleman, J. P. Williams, G. M. Tierney & J. N. Lund

  4. University of Manchester Academic Health Sciences Centre, Manchester, UK

    I. D. Anderson

  5. Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK

    D. Cromwell

  6. Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK

    D. Cromwell

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  1. H. Boyd-Carson
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  2. B. Doleman
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  3. D. Cromwell
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  7. J. N. Lund
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  8. I. D. Anderson
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for The National Emergency Laparotomy Audit Collaboration

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Correspondence to H. Boyd-Carson.

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Boyd-Carson, H., Doleman, B., Cromwell, D. et al. Delay in Source Control in Perforated Peptic Ulcer Leads to 6% Increased Risk of Death Per Hour: A Nationwide Cohort Study. World J Surg 44, 869–875 (2020). https://doi.org/10.1007/s00268-019-05254-x

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  • DOI: https://doi.org/10.1007/s00268-019-05254-x

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