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Impact of Preoperative Physiological Risk Profile on Postoperative Morbidity and Mortality After Emergency Operation of Complicated Peptic Ulcer Disease

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Abstract

Aim

The aim of this study was to evaluate the preoperative physiological risk profile for postoperative morbidity and mortality after emergency treatment of complicated peptic ulcer disease (PUD).

Methods

Operative notes and hospital files of 261 patients—111 female, 150 male; median age 67 years (range 17–100 years)—undergoing an emergency operation from 1993 to 2005 were analyzed retrospectively. The physiologic subscore of the POSSUM score (POSSUM-phys) was analyzed with regard to predicting postoperative complications. Follow-up was obtained from questionnaires sent to family practitioners or by patient interviews.

Results

The overall complication rate was 44%, and mortality was 24%. Among risk factors studied (e.g., sex, patient’s age, duration of symptoms, type of surgery), a high POSSUM-phys score was the strongest predictor for postoperative sepsis, anastomotic/suture dehiscence, postoperative bleeding, and mortality. Cut points for patients at risk could be calculated. Surgical procedures (organ-preserving versus resection) had no influence when matched for POSSUM-phys score. Nevertheless, organ resections were associated with higher scores. Recurrent PUD was a rare event (7.6%).

Conclusion

The preoperative physiologic POSSUM score is a promising instrument for identifying patients at increased risk to develop major postoperative complications after emergency surgery for complicated PUD. Prospective studies are needed to prove its applicability for adjusting treatment to individual patients.

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References

  1. Mikulicz J (1885) Ueber Laparotomie bei Magen- und Darmperforation. Leipzig, Breitkopf

    Google Scholar 

  2. Svanes K, Stangeland L, Viste A, et al. (1995) Morbidity, ability to swallow, and survival, after oesophagectomy for cancer of the oesophagus and cardia. Eur J Surg 161:669–675

    PubMed  CAS  Google Scholar 

  3. Svanes C, Ovrebo K, Soreide O (1996) Ulcer bleeding and perforation: non-steroidal anti-inflammatory drugs or Helicobacter pylori. Scand J Gastroenterol Suppl 220:128–131

    PubMed  CAS  Google Scholar 

  4. Lassen A, Hallas J, Schaffalitzky de Muckadell OB (2006) Complicated and uncomplicated peptic ulcers in a Danish county 1993–2002: a population-based cohort study. Am J Gastroenterol 101:945–953

    Article  PubMed  Google Scholar 

  5. Gisbert JP, Legido J, Garcia-Sanz I, et al. (2004) Helicobacter pylori and perforated peptic ulcer prevalence of the infection and role of non-steroidal anti-inflammatory drugs. Dig Liver Dis 36:116–120

    Article  PubMed  CAS  Google Scholar 

  6. Wolfe MM, Lichtenstein DR, Singh G (1999) Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 340:1888–1899

    Article  PubMed  CAS  Google Scholar 

  7. Paimela H, Tuompo PK, Perakyl T, et al. (1991) Peptic ulcer surgery during the H2-receptor antagonist era: a population-based epidemiological study of ulcer surgery in Helsinki from 1972 to 1987. Br J Surg 78:28–31

    Article  PubMed  CAS  Google Scholar 

  8. Stabile BE, Passaro E Jr (1993) Surgery for duodenal and gastric ulcer disease. Adv Surg 26:275–306

    PubMed  CAS  Google Scholar 

  9. Marshall BJ, Warren JR (1984) Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1:1311–1315

    Article  PubMed  CAS  Google Scholar 

  10. Dubois F (2000) New surgical strategy for gastroduodenal ulcer: laparoscopic approach. World J Surg 24:270–276

    Article  PubMed  CAS  Google Scholar 

  11. Zittel TT, Jehle EC, Becker HD (2000) Surgical management of peptic ulcer disease today: indication, technique and outcome. Langenbecks Arch Surg 385:84–96

    Article  PubMed  CAS  Google Scholar 

  12. Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78:355–360

    Article  PubMed  CAS  Google Scholar 

  13. Bobrzynski A, Beben P, Budzynski A, et al. (2002) Incidence of complications of peptic ulcers in patients with Helicobacter pylori (Hp) infection and/or NSAID use in the era of Hp eradication. Med Sci Monit 8:CR554–557

    PubMed  Google Scholar 

  14. Paimela H, Oksala NK, Kivilaakso E (2004) Surgery for peptic ulcer today: a study on the incidence, methods and mortality in surgery for peptic ulcer in Finland between 1987 and 1999. Dig Surg 21:185–191

    Article  PubMed  CAS  Google Scholar 

  15. Schwesinger WH, Page CP, Sirinek KR, et al. (2001) Operations for peptic ulcer disease: paradigm lost. J Gastrointest Surg 5:438–443

    Article  PubMed  CAS  Google Scholar 

  16. Bulut OB, Rasmussen C, Fischer A (1996) Acute surgical treatment of complicated peptic ulcers with special reference to the elderly. World J Surg 20:574–577

    Article  PubMed  CAS  Google Scholar 

  17. Lipof T, Shapiro D, Kozol RA (2006) Surgical perspectives in peptic ulcer disease and gastritis. World J Gastroenterol 12:3248–3252

    PubMed  Google Scholar 

  18. Behrman SW (2005) Management of complicated peptic ulcer disease. Arch Surg 140:201–208

    Article  PubMed  Google Scholar 

  19. Bornman PC, Krige JE (2004) New paradigms in the management of complicated peptic ulcers: the final requiem for vagotomy? S Afr J Surg 42:113–115

    PubMed  CAS  Google Scholar 

  20. Noguiera C, Silva AS, Santos JN, et al. (2003) Perforated peptic ulcer: main factors of morbidity and mortality. World J Surg 27:782–787

    Article  PubMed  Google Scholar 

  21. Wysocki A, Biesiada Z, Beben P, et al. (2000) Perforated gastric ulcer. Dig Surg 17:132–137

    Article  PubMed  CAS  Google Scholar 

  22. Makela JT, Kiviniemi H, Ohtonen P, et al. (2002) Factors that predict morbidity and mortality in patients with perforated peptic ulcers. Eur J Surg 168:446–451

    Article  PubMed  Google Scholar 

  23. Testini M, Portincasa P, Piccinni G, et al. (2003) Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer. World J Gastroenterol 9:2338–2340

    PubMed  Google Scholar 

  24. Hall JC, Hall JL (1996) ASA status and age predict adverse events after abdominal surgery. J Qual Clin Pract 16:103–108

    PubMed  CAS  Google Scholar 

  25. Jones HJ, de Cossart L (1999) Risk scoring in surgical patients. Br J Surg 86:149–157

    Article  PubMed  CAS  Google Scholar 

  26. Sillakivi T, Lang A, Tein A, et al. (2000) Evaluation of risk factors for mortality in surgically treated perforated peptic ulcer. Hepatogastroenterology 47:1765–1768

    PubMed  CAS  Google Scholar 

  27. Blomgren LG (1997) Perforated peptic ulcer: long-term results after simple closure in the elderly. World J Surg 21:412–414; discussion 414–415

    Article  PubMed  CAS  Google Scholar 

  28. Hermansson M, Stael von Holstein C, Zilling T (1999) Surgical approach and prognostic factors after peptic ulcer perforation. Eur J Surg 165:566–572

    Article  PubMed  CAS  Google Scholar 

  29. Tsugawa K, Koyanagi N, Hashizume M, et al. (2001) The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age. Hepatogastroenterology 48:156–162

    PubMed  CAS  Google Scholar 

  30. Gilliam AD, Speake WJ, Lobo DN, et al. (2003) Current practice of emergency vagotomy and Helicobacter pylori eradication for complicated peptic ulcer in the United Kingdom. Br J Surg 90:88–90

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, 24105, Kiel, Germany

    Jan-Hendrik Egberts, Birte Summa, Clemens Schafmayer, Sebastian Hinz & Juergen Tepel

  2. Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Brunswiker Strasse 10, 24105, Kiel, Germany

    Ulrike Schulz

Authors
  1. Jan-Hendrik Egberts
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  2. Birte Summa
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  3. Ulrike Schulz
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  4. Clemens Schafmayer
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  5. Sebastian Hinz
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  6. Juergen Tepel
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Correspondence to Juergen Tepel.

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Egberts, JH., Summa, B., Schulz, U. et al. Impact of Preoperative Physiological Risk Profile on Postoperative Morbidity and Mortality After Emergency Operation of Complicated Peptic Ulcer Disease. World J Surg 31, 1449–1457 (2007). https://doi.org/10.1007/s00268-007-9061-z

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  • DOI: https://doi.org/10.1007/s00268-007-9061-z

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