Preoperative and intraoperative factors affecting mortality in patients operated on for peptic ulcer perforation: a single center retrospective study

Year 2021, Volume: 4 Issue: 3, 344 - 348, 21.05.2021

Abdullah Şenlikci Koray Koşmaz Abdullah Durhan Ümit Mercan Marlen Süleyman

https://doi.org/10.32322/jhsm.907093

Abstract

Aim: Peptic ulcer perforation (PUP) is currently the most common complication of peptic ulcer disease (PUD), which requires surgery. Mortality and morbidity rates are high after surgical treatment. The aim of this study was to determine the predictive factors affecting postoperative mortality in patients undergoing surgery due to peptic ulcer perforation.
Methods: The study included 135 patients diagnosed and operated on because of PUP in the general surgery clinic between February 2015 and January 2020. Evaluations were made of the relationships between mortality and age, gender, ASA scores, season of surgery, preoperative leukocyte, preoperative neutrophil to lymphocyte ratio (NLR), preoperative creatinine and amylase values, location and diameter of the perforation, comorbid diseases, onset of pain and time of surgery.
Results: Advanced age, male gender, high ASA score, >12 hours between the onset of the symptoms and the time of surgery, and high creatinine, NLR and amylase values before surgery, ulcer diameter >1 cm and comorbid diseases were associated with mortality. No relationship was found between the location of the ulcer and leukocyte values at the time of admission and mortality.
Conclusion: Advanced age, male gender, high ASA score, >12 hours between the onset of symptoms and the time of surgery, and high preoperative creatinine, NLR and amylase values, ulcer diameter >1 cm and comorbid diseases are risk factors for mortality in peptic ulcer perforation. Understanding these factors, identifying patients at risk, and early intervention can help reduce mortality in PUP.

Keywords

Peptic ulcer perforation, mortality, peptic ulcer disease

References

• Zelickson MS, Bronder CM, Johnson BL, et al. Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation.Am Surg 2011; 77: 1054–60.
• Thorsen K, Glomsaker TB, von Meer A, Søreide K, Søreide JA. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg 2011; 15: 1329–35.
• Tanrikulu Y, Tanrikulu CS, Sabuncuoglu MZ, Kokturk F, Temi V, Bicakci E. Is the neutrophil-to-lymphocyte ratio a potential diagnostic marker for peptic ulcer perforation? A retrospective cohort study. Am J Emerg Med 2016; 34: 403–6.
• Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion 2011; 84: 102–13.
• Koçer B, Sürmeli S, Solak C, et al. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol 2007; 22: 565–70.
• Sarosi GA, Jaiswal KR, Nwariaku FE, Asolati M, Fleming JB, Anthony T. Surgical therapy of peptic ulcers in the 21st century: more common than you think. Am J Surg 2005; 190: 775-9.
• Chalya PL, Mabula JB, Koy M, et al. Clinical profile and outcome of surgical treatment of perforated peptic ulcers in Northwestern Tanzania: A tertiary hospital experience. World J Emerg Surg 2011; 6: 31.
• Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg 2009; 33: 80–5.
• Zittel TT, Jehle EC, Becker HD. Surgical management of peptic ulcer disease todayindication, technique and outcome. Langenbecks Arch Surg 2000; 385: 84–96.
• Mäkelä J, Laitinen S, Kairaluoma MI. Complications of peptic ulcer disease before and after the introduction of H2 receptor antagonists. Hepatogastroenterology 1992; 39: 144–8.
• Casali JJ, Franzon O, Kruel NF, Neves BD. Epidemiological analysis and use of rapid urease test in patients with perforated peptic ulcers. Rev Col Bras Cir 2012; 39: 93–8.
• Søreide K, Thorsen K, Harrison EM, Bingener J, Moller MH, Ohene-Yeboah M. Perforated peptic ulcer. Lancet 2015; 386: 1288–98.
• Sivaram P, Sreekumar A. Preoperative factors influencing mortality and morbidity in peptic ulcer perforation. Eur J Trauma Emerg Surg 2018; 44: 251–7.
• Aydın O, Pehlivanlı F. Is the Platelet to lymphocyte ratio a potential biomarker for predicting mortality in peptic ulcer perforation? Surg Infect (Larchmt) 2019; 20: 326-31.
• Arveen S, Jagdish S, Kadambari D. Perforated peptic ulcer in South India: an institutional perspective. World J Surg 2009; 33: 1600–4.
• Taj MH, Mohammad D, Qureshi SA. Outcome of omentopexyas primary repair in perforated duodenal ulcer. J Coll Physicians Surg Pak 2007; 17: 731–5.
• Testini M, Portincasa P, Piccinni G, Lissidini G, Pellegrini F, Greco L. Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer. World J Gastroenterol 2003; 9: 2338-40.
• Kim J-M, Jeong S-H, Lee Y-J, et al. Analysis of risk factors for postoperative morbidity in perforated peptic ulcer. J Gastric Cancer 2012; 12: 26–35.
• Taş I, Ülger BV, Önder A, et al. Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulus Cerrahi Derg 2014; 31: 20–5.
• Kujath P, Schwandner O, Bruch HP. Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery. Langenbecks Arch Surg 2002; 387: 298–302.
• Barut I, Tarhan OR, Cerci C, Karaguzel N, Akdeniz Y, Bulbul M. Prognostic factors of peptic ulcer perforation. Saudi Med J 2005; 26: 1255–9.
• Unver M, Fırat O, Unalp OV, et al. Prognostic factors in peptic ulcer perforations: a retrospective 14-year study. Int Surg 2015; 100: 942–8.
• Proctor MJ, Morrison DS, Talwar D, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 2011; 47: 2633–41.
• de Jager CP, van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care 2010; 14: R192.
• Suriya C, Kasatpibal N, Kunaviktikul W, Kayee T. Diagnostic indicators for peptic ulcer perforation at a tertiary care hospital in Thailand. Clin Exp Gastroenterol 2011; 4: 283–9.
• Møller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW. The Peptic ulcer perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand 2012; 56: 655-62.
• Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg 1987; 205: 22–6.