Perforated peptic ulcer. Determinants of morbidity and mortality

A review of 109 patients with perforated peptic ulcer revealed a sex ratio of 60:49, male:female, with mean age of 67 (76 patients greater than or equal to age 50). Peritoneal cultures were positive in 52 per cent, with the most common organisms streptococci and fungi. Subsequent infectious morbidity with these organisms was rare. Postoperative respiratory and renal failure were associated with intraoperative hypotension (systolic pressure less than 90 mm Hg). Mortality was associated with age greater than 55 and intraoperative hypotension. We conclude that in the 1980s perforated peptic ulcer occurs most frequently in older patients and that acid stomach contents does not ensure sterility, yet subsequent infectious morbidity is rare. Intraoperative hypotension, which occurs especially in patients greater than 55 years, results in significant morbidity and mortality. Attention to preoperative and intraoperative resuscitation is the single most effective therapy for reducing morbidity and mortality from this disease.