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An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Early post-operative morbidity and mortality predictors in peptic ulcer perforation
Metin Yalcin1, Serdar Oter2, Alper Akınoğlu3
1Department of General Surgery, Antalya Training and Research Hospital, Antalya-Türkiye.
Insights
Older age, delayed surgery, and severe contamination predict higher mortality in peptic ulcer perforation (PUP) patients. Early intervention and comprehensive care are vital for improving outcomes in acute abdominal emergencies.
Area of Science:
- Gastroenterology
- Surgical Emergencies
- Clinical Epidemiology
Background:
- Peptic ulcer perforation (PUP) is a significant cause of acute abdomen, accounting for 5% of all abdominal emergencies.
- Numerous factors influencing morbidity and mortality post-PUP have been identified.
Purpose of the Study:
- To analyze factors affecting mortality and morbidity in patients undergoing surgery for peptic ulcer perforation.
- To identify independent predictors of adverse outcomes in PUP patients.
Main Methods:
- Retrospective evaluation of 318 patients operated for PUP between January 2008 and January 2018.
- Analysis of patient demographics, comorbidities, ASA scores, biochemical and hematological parameters, complications, and mortality.
- Multivariate analysis to identify independent risk factors for morbidity and mortality.
Main Results:
- Key predictors of morbidity and mortality included age ≥60 years, perforation-surgery interval >24 hours, purulent intraperitoneal contamination, pre-operative renal failure, duodenal perforation, and pre-operative shock.
- Mortality occurred in 4.71% of patients (15 out of 318).
- Gender was not a statistically significant predictor of outcomes.
Conclusions:
- Age, delayed surgery, contamination severity, pre-operative renal failure, duodenal location, and shock are independent predictors of post-operative morbidity and mortality in PUP.
- Comprehensive clinical evaluation, fluid resuscitation, timely antibiotics, and early surgical intervention are crucial for reducing PUP-related risks.
Background:
Peptic ulcer perforation (PUP) is one of the cause of acute abdomen, incidence of this entity is 5% of all abdominal emergencies. Numerous prognostic factors have been reported for morbidity and mortality after PUP, this study attempts to analyze the factors affecting mortality and morbidity in patients with PUP.
Methods:
The medical record of patients who were operated for PUP in our clinic was retrospectively evaluated between January 2008 to January 2018. A total of 318 patients were included in this study. Patients were retrospectively analyzed in terms of age, gender, comorbidity, ASA score, biochemical, hematological parameters, complications, and mortality. The risk factors affected to morbidity and mortality were also evaluated.
Results:
The study population consisted of 318 patients and the mean age of the patients was 41.30±19.37 (min-max: 16-89). In the study, 271 (85.22%) patients were male and 47 (14.78%) were female and male to female ratio was 5.76. In the analysis of the predictors of morbidity, age ≥60 years, (p<0.001); perforation-surgery interval >24 h (p<0.001); purulent intraperitoneal contamination (p<0.001); pre-operative renal failure (p<0.001); duodenal perforation (p<0.001); pre-operative shock (p<0.001); and ASA score > III (p<0.0001) were found statistically significant. Gender was not found statistically significant (p=0.672). Mortality developed in 15 (4.71%) of 318 patients in the post-operative period. In the multivariate analysis, age ≥60 years, (p<0.001); perforation-surgery interval >24 h (p<0.001); purulent intraperitoneal contamination (p<0.001); pre-operative renal failure (p<0.001); duodenal perforation (p<0.001); and pre-operative shock (p<0.001) were found to be independent predictors of post-operative mortality.
Conclusion:
In our study, age ≥60 years, perforation-surgery interval >24 h, purulent intraperitoneal contamination, pre-oper-ative renal failure, duodenal perforation, pre-operative shock, and intensive care unit in the post-operative period were found to be independent predictors of post-operative morbidity and mortality. A comprehensive clinical evaluation, adequate fluid resuscitation, initiation of appropriate antibiotic therapy, and early access to surgery can minimize the risk of morbidity and mortality in PUP.
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