Perforated Peptic Ulcer: Mortality and Morbidity in 603 Cases

A retrospective study of 603 instance of perforated peptic ulcer occurring over the period from 1944 to 1964 is presented with reference to annual and seasonal incidence, sex ratios, mortality and the factors affecting it, and immediate morbidity. Of special note are: (a) the highly significant increase in the proportion of females in Newcastle, New South Wales; (b) the markedly lower pyloro-duodenal: gastric ratio as compared with that reported in overseas figures; (c) a previously unreported relationship between the actual act of drinking chilled beer and perforation and (d) the very highly significant relationship between the death rate and the sise of the performation.

A series of 603 instances of perforated peptic ulcer over a period of 21 years until 1964 is presented. There has been no real change in the relative incidence of perforation in gastric, pyloric and duodenal ulcers over that time interval, and none in the annual incidence. On the contrary, there has been a highly significant increase in the proportion of females, and the pyloroduodenal: gastric ratio in females is less than unity, a most marked variation from European figures. The seasonal incidence of perforated ulcer in Newcastle, Australia, is remarkably constant. A previously unreported relationship between the actual act of drinking chilled beer and perforation is noted. The overall mortality rate was 15.4%, 7.8% in patients who were operated on and 72.8% in those who were not. There was a single operative death among 80 females. In operations on males, gastric performations were the most lethal to a highly significant degree. Increase in age and delay in operation adversely affect the operative death rate. The prognosis is further worsened by perforation in hospital, posterior wall perforation, perforation associated with gastro-intestinal haemorrhage, admission to a non-surgical service and, of course, mis-diagnosis. A very highly significant relationship was noted between the death rate and the size of the perforation. The young seek advice earlier than the old, and males earlier than females. The immediate morbidity is high, with a postoperative pneumonia rate of 42.9% and a wound infection rate of 31.9%. A significant relationship is seen between subphrenic abscess and gastric perforation.