Prognostic factors of peptic ulcer perforation

OBJECTIVE: Today a perforated peptic ulcer (PPU) is a rare condition. However, emergency surgery for perforated ulcer presently carries a mortality risk of up to 30%. The aim of this study is to analyze and define factors influencing surgical prognosis in patients operated upon for PPU.

METHODS: We performed a retrospective analysis of 62 patients treated for PPU in Suleyman Demirel University, Surgical Department between January 1995 to January 2004. Univariate analysis was performed to determine risk factors for mortality in PPU by chi-square test, Pearson and Spearman correlation tests using SPSS for Windows statistical software. We accepted statistical significance for p values <0.05.

RESULTS: The overall mortality rate was 17.7%. The present study confirms the age, sex, American Society of Anesthesiology (ASA) classification, coexisting medical disease, elapsed time from symptoms to operation, blood pressure, pulse, serum albumin and creatinine levels, hemoglobin level and diameter of perforation as valid prognostic factors in whole series, whereas a previous history of peptic ulcer disease, chronic ingestion history of nonsteroidal anti-inflammatory drugs, alcohol ingestion, smoking habits, site of perforation, type of surgical treatment (simple suture or resection), postoperative complications did not appear to be related to prognosis.

CONCLUSION: Age, gender, ASA classification, coexisting medical disease, elapsed time from symptoms to operation, blood pressure, pulse, serum albumin and creatinine levels, hemoglobin level and diameter of perforation are factors significantly associated with fatal outcomes in patients undergoing emergency surgery for PPU. Thus, such factors need to be carefully taken into account during the general workup of patients admitted for PPU.