[Perforation of gastroduodenal ulcer: a risk analysis]

In 90 patients who, between 1.1.1986 and 31.12.1991, underwent surgery for a perforated gastric/duodenal ulcer, the importance of age, sex, ulcer history, ulcer site, free/covered perforation, extent of peritonitis, duration of history and the pre-operative risk assessment (ASA classification) was analysed with respect to the risk of dying of the perforated ulcer. The univariate analysis showed the following to be prognostically relevant factors: time interval between onset of acute symptoms and surgery (less than or equal to 24 hours: mortality rate 12%, greater than 24 hours: mortality rate 21%; p = 0.006); physical status of the patient as reflected in the ASA category prior to surgery (mortality: ASA II 0%, ASA III 8%, ASA IV 32%; p = 0.009), and the presence of a spontaneous pneumoperitoneum (free perforation 21% mortality, covered perforation 5% mortality; p = 0.049). Investigation of the overall influence of the univariate relevant factors in the logistic model showed a relative risk of 4.9 for duration of history, and of 5.4 for the ASA classification. The mortality risk for a patient who is operated on more than 24 hours after onset of the acute symptoms is 4.9 times that of a patient operated on within 24 hours. In the ASA classification, the mortality risk increases by 5.4 from one category to the next higher one.