Perforated Peptic Ulcer: Clinical Presentation, Surgical Outcomes, and the Accuracy of the Boey Scoring System in Predicting Postoperative Morbidity and Mortality

Lohsiriwat, Varut; Prapasrivorakul, Siriluck; Lohsiriwat, Darin

doi:10.1007/s00268-008-9796-1

Cited by 123 publications

(142 citation statements)

References 28 publications

(47 reference statements)

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“…Consistent with the literature, we found that a large perforation diameter significantly increases morbidity and mortality (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Duration of postoperative hospital stay of patients operated for PUP ranges between 7 and 12.5 days (37)(38)(39).…”

supporting

confidence: 75%

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Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Hut

Tatar²,

Dogan

et al. 2017

Turk J Surg

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INTRODUCTIONWith regard to creating a novel vision for former diseases, our memorizationsshould be updated. Some diseases and their outcomes, which have been previously very well known, are nowadays almost always presented as unexpected cases because of new technologies and evolvements in medicine due to resistant events. Thus, antiulcer medication and presentation of elderly patients have changed in peptic ulcer perforation (PUP) and, transforming the patient profiles with PUP in our era. Therefore, a novel vision to avoid gaps is necessary to evaluate the patients with PUPsas surgeons are coming across newer patient profiles in last decades. Peptic ulcers are focal defects in the stomach and the duodenum extending below the mucosa or deeper (1, 2). They can be acute or chronic; the etiology of the condition is the disruption of balance between gastric acid effect and mucosal defense mechanisms (2, 3). Although medical treatments such as H2 receptor antagonists, proton pump inhibitors, and Helicobacter pylori eradication through antibacterial drugs, have decreased the number of surgeries in non-complicated peptic ulcer cases, the number of patients presenting to the emergency clinics with peptic ulcer perforation has not decreased (1-5).Peptic ulcer perforation is still an important health problem, despite the decreasing incidence of peptic ulcer disease. The aim of this study was to investigate factors affecting the mortality and morbidity of PUPs and specifically determine approaches to decrease mortality. MATERIAL AND METHODSThe data from 112 patients operated with the diagnosis of PUP at our Training and Research Hospital between January 2010 and December 2015 were retrospectively analyzed. Patient age, gender, weight, height, American Society of Anesthesiologists (ASA) score, symptoms, time interval between symptom onset and surgery, accompanying diseases, length of hospital stay, operative technique, laboratory findings, site and diameter of perforation, Acute Physiology and Chronic Health Evaluation (APACHE) II and Mannheim Peritonitis Index (MPI) scores, preoperative shock state, morbidity, and mortality were recorded. MPI (Table 1) and APACHE II scores were calculated for all patients. Patient age, chronic health status, rectal temperature, mean arterial blood pressure, heart rate, respiratory rate, arterial pH, partial oxygen pressure, serum sodium, serum potassium, serum creatinine, hematocrit, white blood cell count, and Glasgow coma score were recorded for determining the APACHE II score. 267Objective: Peptic ulcer perforation is a life-threatening situation requiring urgent surgical treatment. A novel vision in peptic ulcer perforation is necessary to fill the gaps created by antiulcer medication, aging of the patients, and presentation of resistant cases in our era. In this study, we aimed to share our findings regarding the effects of various risk factors and operative techniques on the mortality and morbidity of patients with peptic ulcer perforation. Material and Methods:Data from 112 patient...

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confidence: 75%

“…Turk J Surg 2017; 33: 267-273 There are many scoring systems for predicting risk of morbidity and mortality in PUP, with ASA and Boey scoring methods being the most commonly used ones (29)(30)(31)(32). However, ASA score is used as an overall surgical risk score rather than just for predicting the risks of PUP.…”

mentioning

confidence: 99%

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Hut

Tatar²,

Dogan

et al. 2017

Turk J Surg

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“…Boey's score, which is a score based on factors such as shock on admission, confounding medical illness, and duration of perforation, has been found to be a useful tool in predicting the outcome. [8] In our opinion the Boey's score is a useful prognostic indicator, only at the fi rst contact center because if used at the tertiary center it would be erroneous as it would not take the preoperative resuscitative treatment into account.…”

Section: Discussionmentioning

confidence: 99%

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

Prabhu¹,

Prasadi²,

Gore³

2015

Int J Med Public Health

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Objective: An attempt to analyze why in spite of prolonged perforation-operation (PO) interval mortality in patients of perforated duodenal ulcers is less in some patients and whether resuscitative measures in PO interval infl uences mortality particularly in a rural hospital. Materials and Methods: A retrospective analysis of 81 cases of perforated duodenal ulcers presenting in the surgical clinic in a rural medical college which is also a tertiary referral center. Resuscitation, if received in the PO interval was recorded, and a corrected score was calculated and compared statistically with the conventional Boey score. Results were analyzed using Microsoft Excel and SPSS 22 software. Results: Sample size of 81 patients had 70 referred and 11 direct patients. Six out of 11 direct patients succumbed (P = 0.545) and six out of 70 patients succumbed in the referred group (P = 0.086) suggesting that patients presenting directly to the tertiary center with a prolonged PO interval without any intervening resuscitation the prognosis is poor whereas a delayed PO with intervening medical intervention has a better prognosis. The PO interval was 23-168 h with a mean of 42.12 (standard deviation 26.86). Conclusion: In a rural referral center, the resuscitation done in the PO interval is signifi cant as the prognosis is better in the group of patients resuscitated in the PO interval even if there is a delay in the surgical intervention whereas the mortality is higher in those group of patients who have come directly to the center and subjected to surgical procedure, but without any resuscitation in the PO interval. Hence, resuscitation in PO interval is paramount for a better prognosis.

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“…Three clinical phases have been identified in the process of PPU [22] . The most simple of the scoring system is Boey scoring system [1,2] which helps in risk stratification post operatively and the parameters includes, • Delay in presentation (>24 hours)…”

Section: Discussionmentioning

confidence: 99%

A Study of Clinical Presentation and Accuracy of the Scoring System (Based on Boey) in Predicting postoperative Morbidity and Mortality of Perforated Peptic Ulcers

R¹

2017

jmscr

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Perforated Peptic Ulcer: Clinical Presentation, Surgical Outcomes, and the Accuracy of the Boey Scoring System in Predicting Postoperative Morbidity and Mortality

Abstract: Perforated peptic ulcer is associated with high rates of mortality and morbidity. The Boey risk score serves as a simple and precise predictor for postoperative mortality and morbidity.

Cited by 123 publications

References 28 publications

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

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

A Study of Clinical Presentation and Accuracy of the Scoring System (Based on Boey) in Predicting postoperative Morbidity and Mortality of Perforated Peptic Ulcers

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