Factors Affecting Mortality and Morbidity in Patients With Peptic Ulcer Perforation

Belma Kocer; Suleyman Surmeli; Cem Solak; Bulent Unal; Betul Bozkurt; Osman Yildirim; Mete Dolapci; Omer Cengiz


J Gastroenterol Hepatol. 2007;22(4):565-570. 

In This Article


We reviewed the records of 269 patients operated on for perforated PU at the Emergency Surgery Department of the Ankara Numune Training and Research Hospital, between January 2001 and January 2004. Patients with perforated malignant tumors or marginal ulcers were excluded.

The diagnosis of perforation was based on clinical features, blood tests, routine laboratory tests and radiological findings (i.e. plain abdominal X-ray) and confirmed intraoperatively in all cases. Clinical factors in relation to morbidity and mortality were investigated using univariate and multivariate analyses. The following factors were analyzed: age; gender; previous ulcer history; associated medical diseases; chronic ingestion of NSAIDs, aspirin, corticosteroids or immunosuppressants; alcohol ingestion and smoking habits; season; ASA status; delayed operation; type of ulcer perforation; presence of shock on admission; and type of operation. The time between presumed perforation and surgery was considered as delayed if it was more than 24 h. All incidences of death within 30 days of operation were accepted as operative mortality.

Ulcer type was analyzed according to four different types. Type I ulcers are located on the lesser curvature at, or proximal to, the incisura; type II ulcers are located both on duodenal and prepyloric areas; type III ulcers are located within 2 cm of the pylorus; and type IV ulcers are located in the proximal stomach or in the gastric cardia.

Surgical approach was performed as a non-definitive operation (simple closure) or as a definitive operation. Simple closure included a Graham patch closure alone or closure combined with an omental patch. Definitive operation included the techniques of vagotomy + antrectomy, vagotomy + pyloroplasty and subtotal gastrectomy + gastroenterostomy.

Statistical Analysis

Data analysis was performed using SPSS for Windows (version 10.0, Chicago, IL, USA). The χ2] test or Fisher's exact test (where appropriate) were used to assess the significance of differences in categorical data. Statistically significant variables assessed by univariate analyses were entered into a multivariate logistic regression analyses to determine independent factors that are predictive of mortality and morbidity. Differences were considered significant when P < 0.05.


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