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Surgical approach and prognostic factors after peptic ulcer perforation
M Hermansson1, C Staël von Holstein, T Zilling
1Department of Surgery, Lund University Hospital, Sweden.
Objective:
To find out which prognostic factors were important in predicting postoperative mortality and length of hospital stay in patients with perforated peptic ulcers.
Design:
Retrospective study.
Setting:
Teaching hospital, Lund, Sweden.
Subjects:
246 patients with perforated peptic ulcer who presented between January 1974 and December 1992.
Intervention:
Cox proportional hazards analysis.
Main Outcome Measures:
Influence of age, sex, coexisting disease, duration of symptoms, site of perforation and operative technique on mortality and length of hospital stay.
Results:
Age over 75 years (p = 0.002), coexisting cardiac or pulmonary disease (p = 0.02), perforation of the cardia or body of the stomach (p = 0.02), lapse of more than 12 hours between start of symptoms and operation (p = 0.006) and type of operation (p < 0.0001) had a significant influence on hospital mortality. Age over 75 years (p < 0.0001) and lapse of more than 12 hours between start of symptoms and operation (p = 0.03) significant influenced the likelihood of a prolonged stay in hospital.
Conclusion:
Patients with perforated peptic ulcers should be operated on as soon as possible. Simple closure is simple and safe with relatively low mortality and short stay in hospital.