Surgical approach and prognostic factors after peptic ulcer perforation.

OBJECTIVE

To find out which prognostic factors were important in predicting postoperative mortality and length of hospital stay in patients with perforated peptic ulcers.

DESIGN

Retrospective study.

SETTING

Teaching hospital, Lund, Sweden.

SUBJECTS

246 patients with perforated peptic ulcer who presented between January 1974 and December 1992.

INTERVENTION

Cox proportional hazards analysis.

MAIN OUTCOME MEASURES

Influence of age, sex, coexisting disease, duration of symptoms, site of perforation and operative technique on mortality and length of hospital stay.

RESULTS

Age over 75 years (p = 0.002), coexisting cardiac or pulmonary disease (p = 0.02), perforation of the cardia or body of the stomach (p = 0.02), lapse of more than 12 hours between start of symptoms and operation (p = 0.006) and type of operation (p < 0.0001) had a significant influence on hospital mortality. Age over 75 years (p < 0.0001) and lapse of more than 12 hours between start of symptoms and operation (p = 0.03) significant influenced the likelihood of a prolonged stay in hospital.

CONCLUSION

Patients with perforated peptic ulcers should be operated on as soon as possible. Simple closure is simple and safe with relatively low mortality and short stay in hospital.