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Epidemiology and Outcomes of Peptic Ulcer Perforation: An Analytical Cross-Sectional Study From a Tertiary Care
Ujala Murmu1, Zenith Kerketta2, Khushboo Rani2
1General Surgery, Rajendra Institute of Medical Science, Ranchi, IND.
Insights
Peptic ulcer perforation (PUP) is a serious condition, especially in India. Delayed presentation, large perforations, and severe anemia significantly increase mortality risk, highlighting the need for early intervention.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Public Health
Background:
- Peptic ulcer perforation (PUP) is a critical complication of peptic ulcer disease (PUD), associated with high morbidity and mortality.
- Risk factors include Helicobacter pylori (H. pylori) infection, NSAID use, and socio-economic factors, particularly in low-resource settings.
- PUP necessitates urgent surgical management.
Purpose of the Study:
- To investigate the clinical characteristics, risk factors, and surgical outcomes of PUP.
- To identify predictors of mortality in patients with PUP.
- To inform strategies for improving patient outcomes in a tribal predominant tertiary care hospital in India.
Main Methods:
- An analytical cross-sectional study involving 82 patients undergoing emergency surgery for PUP.
- Data collected included demographics, clinical presentation, H. pylori status, surgical procedures, and outcomes.
- Statistical analysis utilized chi-square, Fisher's exact tests, and multivariate logistic regression for mortality prediction.
Main Results:
- The majority of patients were male (84.14%), with a significant proportion aged 18-40 years (47.56%) and from lower socio-economic classes (41.47%).
- Duodenal perforations were most common (48.78%), with a high prevalence of H. pylori infection (82.5%).
- Delayed presentation (>48 hours), perforation size >2 cm, and severe anemia were significant predictors of mortality (13.42% overall mortality).
Conclusions:
- PUP poses a substantial health burden in India, influenced by delayed presentation, perforation size, and severe anemia.
- Early symptom presentation and prompt surgical intervention are crucial for improving outcomes.
- Effective management of severe anemia is vital in reducing PUP-related mortality.
Abstract:
Background Peptic ulcer perforation (PUP) is a life-threatening complication of peptic ulcer disease (PUD), with significant morbidity and mortality, particularly in low-resource settings. Driven by factors such as Helicobacter pylori (H. pylori) infection, non-steroidal anti-inflammatory drugs (NSAIDs) use, and socio-economic disparities, PUP requires urgent surgical intervention. This study investigates clinical characteristics, risk factors, and surgical outcomes of PUP in a tribal predominant tertiary care hospital in India. Methods This analytical cross-sectional study enrolled 82 patients undergoing emergency surgery for PUP at a tertiary care centre in Ranchi, India. Patients aged >18 years with confirmed or suspected PUP were included, excluding those with sealed perforation. Data on demographics, clinical presentation, H. pylori status, surgical procedures, and outcomes were collected. Statistical analysis was performed using chi-square and Fisher's exact tests, with multivariate logistic regression to identify mortality predictors. Results Of 82 patients, 84.14% were male, 47.56% aged 18-40 years, and 41.47% from lower socio-economic classes. Duodenal perforations (48.78%) were most common, with 82.5% testing positive for H. pylori (p<0.0001). Delayed presentation (>48 hours) increased mortality risk [Odds Ratio (OR)=3.50, p=0.004], with 22.44% mortality. Perforation size of >2 cm (OR=3; p=0.010)and severe anaemia (OR=2.90; p=0.013) were significant mortality predictors. Graham's patch (n=46) had three cases of postoperative anastomotic leak, although not statistically significant (p=0.282). Complications included pleural effusion (24.39%) and surgical site infection (13.42%), with 13.42% overall mortality. Conclusion PUP remains a significant burden in India, driven by delayed presentation, size of perforation, and presence of severe anaemia. Early presentation of symptoms, early surgical intervention, and management of anaemia are crucial to improving outcomes.
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