Risk factors influencing postoperative outcome in patients with perforated peptic ulcer: a prospective cohort study

Abstract

Background

Perforated peptic ulcer (PPU) has been associated with substantially high incidence of morbidity and mortality. The aim of this study was to analyze the factors affecting the outcome of patients having perforated peptic ulcer undergoing surgical intervention.

Materials and methods

Medical records of 112 patients with PPU who underwent emergency laparotomy between December 2014 and November 2016 were prospectively analyzed. Primary suture of the perforation and pedicled omentoplasty was done in all the patients. Data regarding patients was collected and correlated with the postoperative outcome.

Results

The overall postoperative morbidity and mortality were 62.5% and 30.4%, respectively. On univariate analysis advanced age (≥ 60 years) [(p = 0.005), (OR = 3.6), (95% CI = 1.5–8.8)], pre-operative shock [(p < 0.001), (OR = 7.4), (95% CI = 2.6–21.0)], delayed presentation (> 24 h) [(p = 0.007), (OR = 4.0), (95% CI = 1.5–11.2)] and raised serum creatinine [(p < 0.001), (OR = 7.7), (95% CI = 3.1–19.0)] were found to be significantly associated with the post-operative morbidity. For mortality, advanced age (≥ 60 year) [(p < 0.001), (OR = 5.02), (95% CI = 2.1–11.9)], pre-operative shock [(p < 0.001), (OR = 19.3), (95% CI = 6.9–53.6)], comorbidity [(p = 0.03), (OR = 6.6), (95% CI = 1.2–35.7)] and raised serum creatinine [(p < 0.001), (OR = 13.1), (95% CI = 4.5–37.8)] were statistically significant factors. Multivariate analysis showed advanced age (≥ 60 years) (p = 0.05) and raised serum creatinine (p = 0.004) as significant factors for increased risk of post-operative morbidity. Advanced age (≥ 60 years), pre-operative shock and raised serum creatinine were found to be independent risk factors influencing post-operative mortality (p < 0.05).

Conclusion

A thorough clinical evaluation, adequate resuscitation, sepsis control, addressing comorbidities and early access to hospital can reduce the risk morbidity and mortality in patients with PPU.

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Available on request.

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Funding

The authors have not received any fund for this study.

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Contributions

MA conception and design; analysis and interpretation of the data; drafting of the article. TM conception and design; final approval of the article. AZR conception and design; critical revision of the article for important intellectual content; final approval of the article. SAAR final approval of the article.

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Correspondence to Meraj Ahmed.

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Approved from institute ethics committee. The work has been reported in line with the STROCSS criteria.

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Ahmed, M., Mansoor, T., Rab, A.Z. et al. Risk factors influencing postoperative outcome in patients with perforated peptic ulcer: a prospective cohort study. Eur J Trauma Emerg Surg (2021). https://doi.org/10.1007/s00068-020-01597-6

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Keywords

  • Perforated peptic ulcer
  • Peptic ulcer
  • Peptic ulcer complications