Study of factors to assess the mortality and morbidity in perforated peptic ulcer disease

Abstract

Background: Perforated peptic ulcer (PPU) is one of the most common surgical emergencies worldwide more so in India. Despite of the decreased incidence of PPU due to proton pump inhibitors, H. pylori treatment regimen and improved awareness over the last decade, the morbidity and mortality of PPU still remain considerably high.Aim: To determine the preoperative and intraoperative factors affecting post-operative morbidity & mortality in patients operated for PPU.Materials & Methods: A prospective observational study of 140 patients who were operated for PPU was done. A detailed data based on age, history of smoking & alcohol intake, concomitant comorbid diseases, shock & abnormal renal function, duration of presentation to hospital after onset of symptoms, peritoneal contamination and size of perforation was obtained. All cases were followed up for a period of 6 months postoperatively for complications.Observation: Increased morbidity & mortality was observed in patients aged above 65 years. 44% of alcoholics had morbidity and 6.6% had mortality. 51.4% patients had concomitant comorbid diseases, of which 51.4% developed post-operative complications & mortality was 8.3%. 40% of cases presenting with shock had morbidity and 4.4% had mortality. 64.3% of cases presenting to hospital after 36 hours had either morbidity or mortality. Majority of patients with purulent peritoneal contamination had either morbidity or mortality. Perforation of size greater than 0.5cm2 showed morbidity in 44% & mortality in 16%. The overall morbidity and mortality of our study is 35% (n=49) and 5% (n=7) respectively.Conclusion: Risk factors for morbidity and mortality in PPU are elderly age, alcoholism, associated medical illness, pre-operative shock & sepsis, improper fluid resuscitation, perforation to surgery interval more than 36 hours, purulent peritoneal collection & perforation of size >0.5 cm2. Important post-operative factors increasing morbidity and mortality include respirat