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Outcomes of Nonoperative Treatment for Gastroduodenal Ulcer Perforation: a Nationwide Study of 14,918 Inpatients in Japan

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Gastroduodenal ulcer perforation is a common abdominal emergency that may be curable without surgical repair in non-elderly patients with localized and stable symptoms. However, the outcomes of nonoperative approaches have rarely been described.

Methods

Using a Japanese national inpatient database, we identified 14,918 patients with gastroduodenal ulcer perforation who were hospitalized and received nonoperative treatment from July 2010 to March 2017. We categorized these patients into three groups according to age: 18 to 64 years (young group, n=8407), 65 to 74 years (old group, n=2616), and ≥75 years (old-old group, n=3895). We investigated the characteristics, treatments, and outcomes in each group.

Results

Most of the patients were men (71%), and the median patient age was 62 years (interquartile range, 47–75 years). The old and old-old groups had more comorbidities than the young group. Whereas most patients were administered proton pump inhibitors and various antibiotics (96% and 90%, respectively), only 58% of patients underwent gastric tube placement. Surgical repair >3 days after admission was performed in 7.1% of all patients (6.3% vs. 7.9% vs. 5.5%, P<0.001). The old and old-old groups showed higher mortality (1.4% vs. 8.3% vs. 18%, P<0.001) and morbidity (6.6% vs. 15% vs. 17%, P<0.001) than the young group. The median length of stay was almost 2 weeks (13 vs. 17 vs. 20 days, P<0.001).

Discussion

Unlike previous studies, many patients aged >65 years received nonoperative treatment in this nationwide cohort. Our findings provide useful information for clinicians and patients hospitalized for gastric ulcer perforation.

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Funding

This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and 20AA2005) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907).

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Authors and Affiliations

  1. Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Takaaki Konishi, Masahiko Tanabe & Yasuyuki Seto

  2. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Takaaki Konishi, Michimasa Fujiogi, Ryosuke Kumazawa, Hiroki Matsui & Hideo Yasunaga

  3. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Michimasa Fujiogi

  4. Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Nobuaki Michihata

  5. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Kiyohide Fushimi

  6. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Yasuyuki Seto

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  1. Takaaki Konishi
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  2. Michimasa Fujiogi
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  4. Ryosuke Kumazawa
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  7. Masahiko Tanabe
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  9. Hideo Yasunaga
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Correspondence to Takaaki Konishi.

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Konishi, T., Fujiogi, M., Michihata, N. et al. Outcomes of Nonoperative Treatment for Gastroduodenal Ulcer Perforation: a Nationwide Study of 14,918 Inpatients in Japan. J Gastrointest Surg 25, 2770–2777 (2021). https://doi.org/10.1007/s11605-021-05003-3

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  • DOI: https://doi.org/10.1007/s11605-021-05003-3

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