Mortality in Perforated Peptic Ulcer Patients After Selective Management of Stratified Poor Risk Cases

Rahman, Mohammad Mominur; Islam, Muhammad; Flora, Sabrina; Akhter, Shahin; Hossain, Syed Shahadat; Karim, Fazlul

doi:10.1007/s00268-007-9165-5

Cited by 17 publications

(15 citation statements)

References 27 publications

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“…The post-operative morbidity rate in peptic ulcer perforation ranges between 21-42% (9,12,25,26). Pulmonary and wound site infections are often considered among post-operative morbidity reasons.…”

Section: Discussionmentioning

confidence: 99%

Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

Taş

Ülger

Önder

et al. 2015

UCD

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Objective: Peptic ulcer perforation continues to be a major surgical problem. In this study, risk factors that influence morbidity and mortality in perforated peptic ulcer disease were examined. Material and Methods:Files of 148 patients who were included in the study due to peptic ulcer perforation between January 2006 and December 2010 were retrospectively analyzed. Data regarding age, gender, complaints, time elapsed between onset of symptoms and hospital admission, physical examination findings, co-morbid diseases, laboratory and imaging findings, length of hospital stay, morbidity and mortality were recorded. Results:The study group included 129 (87.2%) male and 19 (12.8%) female patients. The mean age was 51.7±20 (15-88) years. Forty five patients (30.4%) had at least one co-morbid disease. In the postoperative period, 30 patients (20.3%) had complications. The most common complication was wound infection. Mortality was observed in 27 patients (18.2%). The most common cause of mortality was sepsis. Multivariate analysis revealed age over 60 years, presence of co-morbidities and Mannheim peritonitis index as independent risk factors for morbidity. Age over 60 years, time to admission and Mannheim peritonitis index were detected as independent risk factors for mortality. Conclusion:Early diagnosis and proper treatment are important in patients presenting with peptic ulcer perforation.Key Words: Peptic ulcer perforation, morbidity, mortality, risk factors, time to admission INTRODUCTION Peptic ulcer disease (PUD) is a disease that results from an imbalance between aggressive factors such as stomach acid and pepsin and mucosa defense barriers (1). Although the need for elective surgery has decreased as a result of advances in medical treatment, 10% of the patients require surgery. The choice of treatment for peptic ulcer perforation (PUP) remains to be surgery. Currently, the most preferred surgical method is simple closure and omental plug. Different techniques are also applied (2-4). Factors that influence the prognosis of PUP are listed as follows: time to hospital presentation, large perforation diameter, age over 60 years, presence of shock, presence of concomitant diseases and localization of the perforation in the stomach (5, 6). Preoperative hemodynamic shock, sepsis and generalized peritonitis are important factors influencing morbidity and mortality (5-8). In this study, we examined the risk factors affecting morbidity and mortality in PUD. MATERIAL AND METHODSThe files of 148 patients, who were operated on at Dicle University, School of Medicine, General Surgery Clinic as diagnosed with PUD and received primary closure + omentoplasty were retrospectively examined after the obtainment of approval from Dicle University, School of Medicine, Ethics Committee with the date and number 18.07.2012/663. Written consents indicating that they allowed their data to be used in medical research were obtained from all our patients. The patients who underwent different surgical procedures or had malignant ulcer per...

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Section: Discussionmentioning

confidence: 99%

Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

Taş

Ülger

Önder

et al. 2015

UCD

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“…13 The prognostic factors reported in the literature include delay in treatment, localization of perforation, age, being female, having coexisting medical problems, having a failed primary surgery, and gastrectomy. 11,12,[14][15][16] Currently, the American Society of Anesthesiologists (ASA) score and the Boey score are the most frequently used prognostic scoring systems in patients with PPU. 8,17,18 The aim of this study was to determine the factors affecting the mortality and morbidity of PUPs and describe the management of PUPs for better results.…”

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confidence: 99%

Prognostic Factors in Peptic Ulcer Perforations: A Retrospective 14-Year Study

Ünver

Fırat

Ünalp

et al. 2015

International Surgery

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Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirtyseven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

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“…In Western countries a distinctly decreased number of elective operations as well as, to a lesser extent, operations performed due to haemorrhage or perforation has been observed [3,4]. However, in the same period there were some reports stating that the number of operations carried out because of PPU did not change or increased [1,5]. A growing tendency of developing perforated ulcer in women has also been noted, in elderly age in particular, as well as increasing PPU incidence in patients who were not conservatively treated previously [6].…”

Section: Introductionmentioning

confidence: 92%

Results of surgical treatment of perforated peptic ulcer

Tarnowski¹,

Bielecki²,

Kamiński³

et al. 2011

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Introduction: Effective treatment with H 2 -blockers and proton pump inhibitors almost removed the necessity of elective surgical treatment of refractory peptic ulcer disease. Life-threatening complications of peptic ulcer still occur and patients with perforated peptic ulcer almost always need surgical treatment. Material and methods: Seventy-five consecutive patients aged 16-91 years (31 women and 44 men) operated on because of perforated peptic ulcer in our department between 1 January 2001 and 31 December 2009 were studied retrospectively. Results: The mean age was 51.5 ±20.5 years. Of the 75 patients, 34 (45.3%) had co-morbid disease, 14 (18.6%) presented with a delay of more than 24 h, 16 (21.3%) were older than 70 years and 25 (33.3%) were assessed as ASA grade 3 or more. Postoperative complications occurred in 19 patients (25.9%). Cardio-pulmonary failure (5 patients) and wound infection (4 patients) were the most common. The mean hospital stay of recovered patients was 7.7 days (3-38). Eleven (14.6%) patients died. Age above 70 years, presence of comorbid illness, presence of abdominal postoperative complications, American Society of Anesthesiologists (ASA) grade 3 or more, presence of shock on admission and gastric localisation of ulcer were identified as factors increasing risk of mortality. Conclusions: The incidence of perforated peptic ulcer among elderly patients, females in particular, is increasing. The number of patients with perforated peptic ulcer as the first symptom of peptic ulcer is increasing. Perforated peptic ulcer still involves high postoperative mortality.

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Mortality in Perforated Peptic Ulcer Patients After Selective Management of Stratified Poor Risk Cases

Abstract: Minimal surgical intervention (percutaneous peritoneal drainage) can significantly lower the mortality rate among a selected group of critically ill, poor risk patients with perforated peptic ulcer disease.

Cited by 17 publications

References 27 publications

Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

Prognostic Factors in Peptic Ulcer Perforations: A Retrospective 14-Year Study

Results of surgical treatment of perforated peptic ulcer

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