Simple severity scale for perforated peptic ulcer with generalized peritonitis: a derivation and internal validation...

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Risk Assessment

Background:

• Perforated peptic ulcer (PPU) with generalized peritonitis necessitates surgery, with outcomes varying by disease severity.
• Developing a validated severity scale is crucial for optimizing patient management and surgical planning.

Purpose of the Study:

• To develop and validate a novel severity scoring system for patients with perforated peptic ulcer (PPU) and generalized peritonitis.
• To identify key predictors of severe postoperative adverse events in PPU patients.

Main Methods:

• Retrospective analysis of a nationwide surgical database (2013-2020) including 12,513 patients.
• Lasso regression models utilized to identify significant predictors of adverse events, with a focus on a derivation cohort (2013-2018) and validation cohorts (2019-2020).
• Evaluation of the scoring system's discrimination and accuracy using C-statistics and calibration plots.

Main Results:

• A 0-11 scoring system was developed, incorporating age, dyspnea, preoperative sepsis, American Society of Anesthesiologists physical status (ASA III-V), albumin, and creatinine.
• The scoring system demonstrated strong predictive accuracy (C-statistics 0.812-0.819).
• A cutoff score of <5 reliably predicted a <3% probability of postoperative adverse events, irrespective of surgical approach.

Conclusions:

• The developed PPU severity score effectively predicts minimal risk for postoperative adverse events when below 5.
• This clinical tool can aid in determining the appropriate surgical strategy for PPU patients.
• Further external validation studies are recommended to confirm the score's generalizability.