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Peptic ulcers in the elderly is a surgical disease
S F Fowler1, J F Khoubian, R A Mathiasen
1Department of Surgery, Cedars-Sinai Medical Center, Suite 8215, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.
Background:
Operative management for peptic ulcer disease (PUD) has changed significantly over the last 30 years.
Methods:
For a 15-year period, records of patients undergoing operative management for peptic ulcer disease were stratified into age groups and examined with respect to presentation, type of operation, and risk factors.
Results:
In all, 154 patients underwent surgery for PUD during the 1990s. Elderly patients were more likely to require an emergent operation (91%, P = 0.005), present with hemodynamic instability (25%, P = 0.025), and have a longer hospital stay (21 days, P = 0.012). Among the elderly in the 1990s as compared with the 1980s, there was increased use of nonsteroidal anti-inflammatory drugs ([NSAIDs] (49%, P = 0.005), decreased tobacco use (22%, P = 0.014), and less likelihood of postoperative renal failure (6%, P = 0.014).
Conclusions:
Elderly patients in the 1990s comprise the majority of cases presenting in a more unstable condition as compared with patients <60 years old, but show similar rates of morbidity and mortality. Elderly patients undergoing surgery for PUD have shown an increase in use of NSAIDs over the last 15 years. The types of procedures have not changed, but operations are more likely to be an emergent basis.