Five year experience in management of perforated peptic ulcer and validation of common mortality risk prediction models – Are existing models sufficient? A retrospective cohort study

Anbalakan, Kamalesh; Chua, Darren; Pandya, Garvi J; Shelat, Vishal G

doi:10.1016/j.ijsu.2014.12.022

Cited by 71 publications

(67 citation statements)

References 30 publications

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“…2,3 Other investigators have also noted increased risk of death with an increasing interval between perforation and initiation of treatment. [20][21][22][23]38 The same has not been observed in this study. The delay in presentation did not have a significant impact on mortality.…”

Section: Discussionsupporting

confidence: 61%

“…Leak rates of 2-8% have been reported after perforation repair. 19,21,22 In the present study the fistula rate was 5%. These unfortunate patients have a 35% chance of mortality.…”

Section: Discussionsupporting

confidence: 46%

“…This is similar to the observations of many other reports of PPU in which almost 80% are males. 22,25 However Saverio D et al from Italy observed that more than half the patients undergoing surgery were females. 26 They were of the opinion that the incidence is more in females due to their longer life expectancy and presence of more co-morbidities leading to a greater use of ulcerogenic medications.…”

Section: Discussionmentioning

confidence: 99%

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The outcome of surgery for perforated peptic ulcer in modern times

Vats¹,

Rehmani²,

Agrawal³

2018

Int Surg J

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Background: A laparotomy for peritonitis due to perforated peptic ulcer is one of the commonest emergency operations done by a general surgeon and is still associated with a marked mortality and morbidity. The aim was to assess the current mortality and morbidity in patients operated for perforated peptic ulcer and to identify the factors associated with increased mortality in these patients.Methods: All adult patients operated for perforated peptic ulcer over a period of one year were included in this prospective observational study. The demographics, clinical presentation, pre-operative laboratory parameters, operative findings, operation done, and the outcomes were noted in pre-designed proforma. Mortality and morbidity was assessed and factors relating to increased mortality were determined using standard statistical tests of significance such as Chi square test and the student’s t test.Results: 55 patients underwent laparotomy for perforated peptic ulcer (23 gastric and 32 duodenal perforations). There were 53 males and only 2 females in the group. Their mean age was 44 years. The mortality was 16% (9/55) and morbidity was 25% (14/55). Complications were encountered in 14 patients, most commonly surgical site infection in 13% cases, entero-cutaneous fistula occurred in 3 patients and one of them expired despite re-exploration due to persistent sepsis. The other two patients survived, and fistula healed spontaneously. The operative procedure done was Graham’s patch or it’s modification. Only 2 patients had antrectomy with Billroth II reconstruction.Conclusions: Despite the advances in management of critically ill patients, the mortality (16%) and morbidity (25%) for this common surgical emergency remains high and is unchanged over the last half century. Presence of comorbidities and low serum albumin are associated with an increased risk of adverse outcome.

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Section: Discussionsupporting

confidence: 61%

“…Leak rates of 2-8% have been reported after perforation repair. 19,21,22 In the present study the fistula rate was 5%. These unfortunate patients have a 35% chance of mortality.…”

Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The outcome of surgery for perforated peptic ulcer in modern times

Vats¹,

Rehmani²,

Agrawal³

2018

Int Surg J

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“…[6,11,12,5] Buck and colleagues on the other hand expressed the meagre ability of Boey score in predicting mortality and morbidity status. [13] Their multicentre study also stated that the ASA score, and sepsis score were not able to provide convincing results in prognostication of patients.…”

Section: Discussionmentioning

confidence: 99%

Frailty of Boey Score in Ppu Mortality and Morbidity Prediction- A Prospective Study

Britto¹,

Kashyap²,

Prakash³

2017

jemds

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BACKGROUNDPeptic ulcer is quite common in our country due to intake of non-steroidal anti-inflammatory drugs, alcohol, spicy diet, smoking and a stressful lifestyle. Almost everybody harbours Helicobacter pylori within them and prone to peptic ulcer. Peptic ulcer can have disastrous complications with one of them being perforation, which is a surgical emergency. Its effects can range from severe abdominal pain to hypotension, sepsis and shock. Hence, timely intervention is absolutely mandatory. Various scoring systems have been developed to prognosticate the morbidity and mortality of perforated peptic ulcer with Boey score being the most commonly followed in various healthcare setup. We tried to determine the role of Boey score in our patients with perforated peptic ulcer and analyse its limitations.

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“…После стандартизации по возрасту и периоду после перелома была выявлена достоверная связь между остеопорозом и саркопенией (p = 0,03). В исследовании Hida T. [49] у пациентов с переломом шейки бедренной кости по сравнению с контрольной группой выявлена более высокая частота саркопении (р < 0,05), наличие которой было признано независимым фактором риска перелома шейки бедренной кости [43].…”

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