Postoperative Morbidity and Mortality of Perforated Peptic Ulcer: Retrospective Cohort Study of Risk Factors among Black Africans in Côte d’Ivoire

Abstract

Introduction. Surgical treatment of perforated peptic ulcer (PPU) is a challenge for surgeons in Africa. Aim. To determine risk factors of postoperative complications or mortality among black Ivoirian patients with PPU. Methods. All 161 patients (median age = 34 years, 90.7 male) operated on for PPU in the visceral and general surgery unit were enrolled in a retrospective cohort study. Variables were studied with Kaplan Meier and Cox proportional hazard models. Results. Among 161 patients operated on for PPU, 36 (27.5%) experienced complications and 31 (19.3%) died. Follow-up results were the incidence of complications and mortality of 6.4 (95% CI: 4.9–8.0) per 100 person-days and 3.0 (95% CI: 1.9–4.0) per 100 person-days for incidence of mortality. In multivariate analysis, risk factors of postoperative complications or mortality were comorbidities (HR = 2.1, P = 0.03), tachycardia (pulse rate > 100/minutes) (HR = 2.4, P = 0.02), purulent intra-abdominal fluid collection (HR = 2.1, P = 0.04), hyponatremia (median value ≤ 134 mEq/L) (HR = 2.3, P = 0.01), delayed time of hospital admission > 72 hours (HR = 2.6, P < 0.0001), and delayed time of surgical intervention between 24 and 48 hours (HR = 3.8, P < 0.0001). Conclusion. The delayed hospital admission or surgical intervention and hyponatremia may be considered as additional risk of postoperative complications or mortality in Black African patients with PPU.

Perforated Peptic Ulcer Disease in a Tertiary Hospital, Addis Ababa, Ethiopia: Five Year Retrospective Study

“…Two third (66.6%) of the deaths occurred on patients who presented within 24 hours after the onset of symptoms. Similar studies done in Turkey, Singapore and Ivory Coast also showed presentation after 24 hours of the onset of symptoms increased both post-operative complications and mortality (10,11,12).…”

Effect of in‐hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi

“…The rate of IHDs of 36·8 per cent in the present study was similar to that in an earlier study at a well staffed teaching hospital in Nigeria, where 50 per cent of patients waited over 24 h, and 16 per cent waited more than 48 h for operative intervention. At a regional hospital in Uganda 48 per cent of 31 operations were delayed (median delay 14·8 h), and in the Ivory Coast 86 per cent of patients had a delay of more than 24 h from symptom onset to surgery, with more than 36 per cent waiting over 48 h. Delays were defined in the present study as longer than 24 h. Most surgeons would agree that this is too long to wait for emergency care, and several other studies, especially in LMICs, have used this definition, although some high‐income countries (HICs) have used shorter times. Future research to measure specific time intervals, including time to decision to operate, time to diagnostic studies and exact times to procedures, should clarify the length of an acceptable in‐hospital wait.…”

“…IHDs have been associated with worse outcomes in both HICs and LMICs 7,10 . The overall mortality rate in the present study of 11⋅8 per cent was similar to rates of 10-19 per cent seen in other series 10,15,24,25 of abdominal operations in the region. In HICs, delays are often considered to have shorter intervals of less than 6 or 12 h 7,8,22 .…”

“…In sub‐Saharan Africa, limited data suggest that IHDs are also associated with worse outcomes for specific conditions. Patients with perforated peptic ulcer disease in the Ivory Coast had a hazard ratio for mortality of 15·6 if surgery was delayed more than 24 h from symptom onset, and in patients with traumatic brain injury in Uganda IHDs increased mortality.…”

“…Delays in surgical intervention for emergency conditions increase mortality. The three primary sources of delay to surgical care for patients in limited‐resource settings include: delay in seeking care (pre‐hospital), delay in transferring to a facility equipped to perform the procedure (interfacility), and delay from presentation at a hospital able to provide definitive care to the start of the operative intervention (in‐hospital delays; IHDs).…”