Risk Factors for Gastrointestinal Leak after Perforated Peptic Ulcer Disease Operative Repair

Abstract

Background There are limited studies regarding the impact of post-operative leak on perforated peptic ulcer disease (PPUD) and conflicting results regarding routine drain placement in operative repair of PPUD. This study aims to identify risk factors for gastrointestinal leak after operative repair of PPUD to better guide intra-operative decisions about drain placement. Methods We performed a retrospective cohort study at a tertiary care center from 2008 to 2019, identifying 175 patients who underwent operative repair of PPUD. Results Patients who developed a leak (17%) were compared to patients who did not. Both hypoalbuminemia (albumin < 3.5 g/dL) ( P = .03) and duodenal ulcers ( P < .01) were identified as significant risk factors for leak. No significant difference was found between leak and no leak groups for AAST disease severity grade, repair technique, or pre-operative use of tobacco, alcohol, or steroids. Post-operative leaks were associated with prolonged hospital stay (29 days compared to 10, P < .01), increased complication rates (77% compared to 48%, P < .01), and increased re-operation rates (73% compared to 26%, <0.01). No difference was identified in patient characteristics or operative leak rates between patients who had drains placed at the index operation and those that did not. Discussion Leak after operative PPUD repair is associated with significant post-operative morbidity. Hypoalbuminemia and duodenal perforations are significant risk factors for post-operative leaks.

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

“…The main cause for reoperation following surgical repair is suture leak. Proposed explanations, based on current literature data, include the difficulty in laparoscopic knot tying, ulcer diameter (> 2 cm) and abdominal contamination [ 49 , 50 ]. Based on our multivariate analysis the factors associated with leak were ulcer site (pyloric/duodenal), higher Boey Score and higher Age-shock index while PULP score revealed his statistically significant association with leakage only at the univariate analysis.…”

Malnutrition and Postoperative Outcomes Following Transcervical Zenker Diverticulectomy

“…However, prealbumin has not been used extensively in previous literature as a marker, possibly due to there being no established definition of malnutrition using prealbumin and a lack of inclusion in databases such as ACS‐NSQIP 24 . Therefore, although no specific marker is currently established as the single best measure of malnutrition, albumin level was used in this study since it was the most available nutritional marker in ACS‐NSQIP in addition to being one of the most frequently used markers for malnutrition in the scientific community due to its simplicity and ease 11–15,24,27,28 . We utilized the ACS‐NSQIP and concluded that within our cohort of transcervical ZD cases, hypoalbuminemia had no significant impact on postoperative outcomes following adjustment for demographics and related comorbidities.…”

“…There are several methods that surgeons can use to screen for malnutrition in surgical patients, yet it is often underdiagnosed 10 . Serum albumin levels are commonly used as a marker to screen for malnutrition, with hypoalbuminemia typically classified as <3.5 g/dl 11–15 . Existing literature has found that hypoalbuminemia is associated with postoperative short‐term complications across procedures from multiple surgical subspecialties.…”

“…For example, Gelfand et al found that serum albumin level was a significant predictor of 30‐day mortality for patients undergoing metastatic spinal disease surgery 15 . Lund et al demonstrated that hypoalbuminemia was associated with increased rates of postoperative leak following operative repair of perforated peptic ulcer disease, and leak was associated with increased postoperative morbidity 12 . Fang et al discovered that the Geriatric Nutritional Risk Index, which incorporates serum albumin levels to determine malnutrition, predicted adverse outcomes in patients after total joint arthroplasty 10 .…”

“…10 Serum albumin levels are commonly used as a marker to screen for malnutrition, with hypoalbuminemia typically classified as <3.5 g/dl. [11][12][13][14][15] Existing literature has found that hypoalbuminemia is associated with postoperative short-term complications across procedures from multiple surgical subspecialties. For example, Gelfand et al found that serum albumin level was a significant predictor of 30-day mortality for patients undergoing metastatic spinal disease surgery.…”