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


Of the 269 patients, 239 (88.8%) were male and 30 (11.2%) were female, with a male to female ratio of 8:1. The disease was most common in the second and third decades; the overall mean age was 43.41 ± 18.66 years (range 16-87 years). Mean age of females was 51.83 ± 22.05 years (range 17-87 years), while the mean age of males was 42.31 ± 17.96 years (range 16-82 years) (P = 0.04). Clinical features of patients with perforated PU are shown in Table 1 . PUP was mainly present in younger male patients (mainly in second and third decades) and in older female patients (mainly in fourth and sixth decades). Seventy-one patients (26.4%) had associated diseases which are listed in Table 2 . Sixty-nine percent of patients (n = 185) had free air under the diaphragm according to a chest X-ray. A simple closure was performed in 95.5% of patients (n = 257), while 12 patients (4.5%) underwent a definitive operation. As a definitive procedure, four patients had simple closure + truncal vagotomy + gastroenterostomy; six patients had simple closure + truncal vagotomy + pyloroplasty; one patient had simple closure + truncal vagotomy + antrectomy, and one patient had subtotal gastrectomy + gastroenterostomy. The choice of surgical procedure depended on several factors; gastric resections were performed only if the ulcers were too large for simple closure, the patients with gastric or duodenal ulcers with severe scarring that cause stenosis or obstruction were operated on with simple closure + bypass procedure. Two patients had a history of operation for PUP and therefore the vagatomy + bypass procedure was performed on these patients. A total 108 postoperative complications were seen in 65 (24.2%) patients ( Table 3 ). Pneumonia and wound infection were the most frequent postoperative complications. A total of 23 patients died (8.5%). The most frequent causes of death were myocardial failure (n = 9, 39.1%) and sepsis (n = 8, 37.8%) ( Table 4 ).

The results of univariate analyses of clinical variables in relation to mortality are presented in Table 1 . A stepwise logistic regression analysis showed that older age, ASA status, delayed admission to hospital, presence of shock, and the type of operation were independent predictors of mortality ( Table 5 ). With every increase in ASA status, risk of mortality increased 4.5 times. Definitive operation increased mortality risk 16.5 times and admission of patients with presence of shock increased mortality 7 times. Patients older than 65 years had 6.4 times higher mortality risk than younger patients. Admission to hospital later than 24 h also increased mortality risk.

Univariate analysis demonstrated that age, associated medical diseases, season, time of surgery, presence of shock, ASA status, perforation size and type of surgery were related to morbidity ( Table 1 ). However, multivariate analysis identified ASA status, time of surgery, season, presence of shock and type of surgery as independent predictors of morbidity. Each increase in ASA status caused an increase in the morbidity risk by 2 times. Patients that were admitted after 24 h had a 3.4 times higher morbidity risk than patients admitted before 24 h ( Table 6 ). In winter, morbidity of patients increased. Time of admission to hospital was the same in every season. However, patients admitted to hospital in winter were older than patients admitted in other seasons. Therefore, this factor might be the reason behind the high morbidity seen in winter.


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