SPECTRUM OF PERFORATED PEPTIC ULCER DISEASE IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA: PREDICTORS OF MORBIDITY AND MORTALITY
Vikram Kate*1, Shreya Agarwal1, Sahla Sathar1, Gurushankari Balakrishnan1, Madan Shivakumar1, Sathasivam Sureshkumar1, Ismail Z. Rifai2, Thulasingam Mahalakshmy2
1Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research., Pondicherry, India; 2Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
Introduction: Peritonitis caused by perforated peptic ulcer remains one of the most common surgical emergencies in India and other developing countries with high morbidity and mortality. The aim of this study was to identify the perioperative risk factors influencing the post-operative morbidity and mortality in patients with perforated peptic ulcer disease, to improve management for better survival and outcome.
Methods: 500 patients who underwent surgery for perforated peptic ulcer in our institution from September 2013 to August 2021 were included in this observational retrospective study and their clinical presentation, peri-operative and postoperative management were studied and analyzed. The demographic profile such as age and gender, other preoperative details such as symptom duration, previous ulcer history, associated medical diseases, chronic ingestion of NSAIDs, alcohol ingestion and smoking habits, presence of shock on admission, abdominal examination findings, and ASA status were noted from the records. Postoperative morbidity and mortality up to 30 days after surgery was noted from the patient's records. Postoperative morbidities such as prolonged intubation, surgical site infection, acute renal failure, ionotropic support requirement, bleeding, deep intra-abdominal collection, burst abdomen, pulmonary complications, re-leak, re-laparotomy, hemodynamic instability, deep vein thrombosis, sepsis, stroke and cardiac complications were recorded.
Results: The mean age of the patients in this study was 46.5 years with a male: female ratio of 24:1. There were 160 patients with duodenal perforation and 328 patients with gastric perforation. The mean hospital stay was 14 days. The most common major and minor postoperative complications were prolonged intubation and pulmonary complaint (including chest infection, unexplained cough and wheezing) respectively. Age > 60 years, presence of comorbid illness, shock at presentation and perforation size > 1 cm were identified as independent predictors of postoperative morbidity in patients with perforated peptic ulcer (Table 1). The overall mortality was 11.6%. The mortality among men and women were 98.2% and 1.7% respectively. Age > 60 years, shock at presentation, presence of rigidity in abdominal examination and size of perforation > 1 cm were identified as independent predictors of mortality in patients with perforated peptic ulcer (Table 2).
Conclusion: The size of peptic ulcer perforation, delay in either medical or surgical intervention, has been found to be an independent risk factor for both postoperative morbidity and mortality. Age, shock at presentation, higher ASA grading, longer duration of surgery, greater volume of bilio-purulent contamination were the other risk factors which need to be considered while managing perforated peptic ulcer patients.
Table 1.
Table 2.
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