A Prospective Study of Operative Risk Factors in Perforated Duodenal Ulcers

Abstract

Operative risk factors for patients with perforated duodenal ulcers were examined prospectively in 213 operated patients. Nine hospital deaths (4.2%) resulted from respiratory failure, sepsis, and bleeding. Forty-five complications developed in 27 patients (12.7%). Concurrent medical illness, preoperative shock, and longstanding perforations (more than 48 hours) were significant features that increased mortality. Old age, gross peritoneal soiling, and the length of the ulcer history did not affect mortality in the absence of risk factors. No death attributable to either sepsis or abscess formation occurred when hurgery was performed within two days of perforation. Bacterial contamination may not signify clinical peritonitis during this period. We conclude that simple closure of perforated ulcers is a more prudent choice when any risk factor is present, but that definitive surgery in good-risk patients merits further evaluation.'A LTHOUGH PERFORATED DUODENAL ULCER remains t a dramatic surgical emergency, nowadays it seldom results in death. The surgical mortality has declined steadily and is now about 5%.1-6 This improvement, as well as the high incidence of ulcer relapse after plication alone, persuaded many surgeons to adopt immediate definitive operations for acute perfora-,ions.'4'3 But emergency curative surgery is never entirely safe, and it can incur a higher mortality than does plication of perforations.2'3 Obviously, patient characteristics are crucial in choosing optimal surgical treatment. Simple closure, or even nonoperative management, is acknowledged to be most appropriate for patients who are markedly debilitated or in shock.3'4'9 11,14-17 Based on retrospective reviews, a number of features were considered contraindications to definitive operations, including shock, old age, perforations of greater than 12 hours duration, and peritoneal contamination." 2.611'13 It is unclear, however, when a perforation should be considered to be so longstanding or peritoneal contamination so excessive that even simple Lclosure would entail substantial risks, and when definitive surgery presumably would be precarious.This prospective study of perforated duodenal ulcers

Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer

“…Such apparent discrepancies might be explained by the characteristics of patients included in the study, and/or by different age or different surgical procedures [16,18] . This study confirmed the previous observations [5,8,15,[25][26][27][28] that shock on admission and delayed operation were both associated with a greater mortality rate.…”

“…steroids, NSAIDs, immunosuppressive agents, etc. ), and the development of an acute, rather than chronic peptic ulcer [5][6][7][8] . In this paper, we studied the main factors associated with mortality in a large number of patients undergoing surgery for perforated peptic ulcers (PPU) in a large referral academic hospital in southern Italy.…”

Evaluation of mortality and morbidity in patients with secondary peritonitis using predictive score of mortality in perforated peptic ulcer

“…[10][11][12] Age over 65 years is an independent risk factor for mortality. 13,14 BUN level is regulated as a result of several conditions such as protein catabolism, steroid intake and gastrointestinal bleeding. Regardless of renal functions, it is also accepted as a marker of a severity of disease".…”

Does resuscitation in perforation-operation interval modify the mortality in duodenal perforations?

“…[13] Many authors have recognized the importance of PO interval and its effect on mortality, but we are of the opinion that the treatment received in this period has a signifi cant effect on reducing the mortality.…”