Risk Factors of Mortality in Patients Hospitalized With Chronic Duodenal Ulcers

Abstract

Background We aimed to identify risk factors of mortality in patients hospitalized with duodenal ulcers (DUs). Methods A National Inpatient Sample–based retrospective cohort study from 2005 to 2014 was conducted on patients undergoing emergency admission for chronic DUs. Demographics, clinical data, and outcomes were collected. Multivariable logistic regression model was applied to find the risk factors of mortality. Results 70 641 patients were included in this study, of which 30 525 (43%) were non-elderly (< 65 years) and 40 116 (57%) were elderly (65+ years) patients. 72% of non-elderly and 57% of elderly patients were males. Mortality rate of men vs women was similar in non-elderly group (1.9% vs 2%, respectively), whereas it significantly differed in elderly patients (4.5% vs 5.3%, respectively, P<.0001). Time to operation was 1.15 (1.83) days in survived vs 1.55 (3.86) days in deceased non-elderly patients ( P < .001). Time to operation was .85 (1.73) days in survived vs 1.79 (7.28) days in deceased elderly patients ( P < .001). In patients with operation, age, delayed operation, frailty, and presence of perforation were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was shown as a protective factor in elderly patients. In the final model for patients with no operation, age, hospital length of stay, and frailty were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was revealed as a protective factor in all patients as well. Conclusion Early operation in patients with DU requiring surgical intervention is essential to improve the outcomes.

Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients

“…This helps explain our findings that adult non-operative patients may be considered higher risk, based on the presence of more comorbidities, and their vulnerability to additional days in the hospital. Interestingly, our study did not find time to operation to be a risk factor for mortality, contrary to other studies where an increased time to operation increased the odd of mortality [ 13 , 25 , 34 , 35 , 38 , 40 ]. While there is ample literature studying the different surgical methods for umbilical hernia repair, there is clearly a need to further investigate the impact of delaying surgery, HLOS, and the non-operative “watchful waiting” approach on the mortality of patients with UH.…”

“…Specifically, there was a 7.7% increase in the odds of mortality for each additional day spent in the hospital. Similarly, associations between mortality and HLOS were noted in multiple recent retrospective studies on patients emergently admitted with gastroparesis, hemorrhoids, duodenal ulcers, blunt chest wall trauma, tracheostomy, rectal malignancy, total hip arthroplasty, and paralytic ileus [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. The HLOS was not a significant predictor for mortality in the elderly sample, despite elderly patients experiencing a longer HLOS ( Table 2 ).…”

Adult and Elderly Risk Factors of Mortality in 23,614 Emergently Admitted Patients with Rectal or Rectosigmoid Junction Malignancy

“…Grass et al assessed the impact of delay from diagnosis to curative surgery on survival in patients with non-metastatic colon cancer and observed that the adjusted hazard ratio for mortality increased with delay times of longer than 30 days, to become significant after a delay of 40 days [ 26 ]. In prior NIS database studies, emergently admitted patients with ventral hernia, chronic duodenal ulcers, or hemorrhoids with previous surgery exhibited longer time to operation among the main risk factors for mortality [ 27 , 28 , 29 , 30 ].…”

Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors

“…An analysis of 33,700 emergently admitted patients with ventral hernia concluded that increased HLOS was a main risk factor for mortality in non-operatively managed patients [ 25 ]. Lin et al revealed significant associations between mortality and increased HLOS in elderly and non-elderly patients hospitalized with chronic duodenal ulcers [ 26 ]. An investigation of 52,786 patients demonstrated increased HLOS was a risk factor for mortality in non-operated emergency hemorrhoid patients [ 27 ].…”