Perforated peptic ulcer: Determinants of outcome and mortality

Sir,

Elective surgery for the management of peptic ulcer disease (PUD) has decreased significantly, but emergency surgical interventions for its complications are still common.[1,2] The objective of our study was to identify variables that are associated with the outcome and mortality of this life-threatening condition.

Charts of patients operated for perforated ulcer in our department over 9 years were reviewed retrospectively. Forty-one patients were operated for perforated PUD. Overall mortality was 27%, mean age of the deceased was 75 vs 51 in the survivors (P < 0.001). Among the survivors, mean age of men was, significantly younger than women (46.4 vs 60.2; P = 0.007). Blood lactate levels were significantly higher in the deceased (5 vs. 2.2 mg/dl, P = 0.019), urinary amylase was significantly higher in the surviving patients (184.7 vs. 1538.31 mg/dl; P = 0.007), other variables were similar in both groups. Diabetes mellitus influence patient's outcome while history of PUD, smoking and the use of NSAIDs did not prove to do so. All variables were compared between patients younger and older than 60 years old. Younger males suffer more perforation (P = 0.0001) and suffer more of PUD prior to perforation. Perforation to operation interval is significantly longer (P = 0.03) in the older patients mostly due to delay in presentation to the hospital.

In conclusion our study shows that in perforated PUD, older age, elevated lactate levels and diabetes might predict an unfavorable outcome even among patients operated in a timely manner. Age is a primary independent risk factor for mortality in patients with perforated PUD. Younger patient suffer more of PUD preoperatively and perforation to operation interval in the older patients was significantly longer.