Preoperative factors influencing mortality and morbidity in peptic ulcer perforation
1Department of General Surgery, Government Medical College, Thiruvananthapuram, 695011, India. sivrm.p@gmail.com.
Insights
Female gender, older age, delayed surgery, and larger perforation size are key factors impacting outcomes in perforated peptic ulcer surgery. Early identification of at-risk patients is crucial for reducing complications.
Area of Science:
- Gastroenterology
- Surgical Emergencies
- Clinical Outcomes Research
Background:
- Perforated peptic ulcer presents a significant global surgical emergency.
- While medical therapies have reduced elective surgeries, perforated peptic ulcer incidence is rising, causing substantial morbidity and mortality.
Purpose of the Study:
- To investigate the association between preoperative and intraoperative factors and postoperative outcomes in patients undergoing surgery for peptic ulcer perforation.
Main Methods:
- A prospective observational study included 101 patients with peptic ulcer perforation treated with laparotomy and simple closure.
- Data collected included demographics, symptom duration, clinical findings, comorbidities, and surgical details.
Main Results:
- Female gender, older age, delayed surgery (>36 hours), and larger perforation size (>1 cm²) significantly correlated with increased postoperative mortality and morbidity.
- Comorbid diseases and abnormal renal function were associated with higher morbidity and longer hospital stays.
Conclusions:
- Understanding these risk factors is vital for identifying high-risk patients.
- Early intervention strategies can potentially decrease postoperative morbidity and mortality in peptic ulcer perforation cases.
Purpose:
Perforated peptic ulcer is one of the most common surgical emergencies worldwide. With the improvement in medical therapy for peptic ulcers, the number of elective surgical procedures has come down. However, the incidence of perforated peptic ulcer is still increasing and remains as a substantial health problem with significant postoperative morbidity and mortality. This study aimed to find out the association between various preoperative and intraoperative factors with the postoperative mortality and morbidity in patients operated for peptic ulcer perforation.
Methods:
This prospective observational study had a time based sample of 101 perforation peritonitis cases admitted to the surgical wards of a tertiary care center from February 2015 to January 2016 who underwent laparotomy, diagnosed to have peptic ulcer perforation and underwent simple closure with an omental patch. Data regarding age, gender, presenting complaints, time elapsed from the onset of symptoms to surgery, physical examination findings, comorbid diseases, laboratory and imaging findings, intraoperative findings, length of hospital stay, postoperative morbidity, and mortality were recorded and analyzed.
Results:
Female gender, older age group, perforation surgery interval more than 36 h, and size of perforation more than 1 cm2 were found to be significant factors influencing postoperative mortality and morbidity. Postoperative morbidity was also associated with comorbid diseases. Abnormal renal function on presentation was identified as an additional risk factor for postoperative morbidity and longer hospital stay.
Conclusions:
An understanding of these factors, identification of patients at risk and early intervention can help in reducing the postoperative morbidity and mortality in peptic ulcer perforation.
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