Department of Anaesthesiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Br J Surg. 2013 Jul;100(8):1045-9. doi: 10.1002/bjs.9175.
Morbidity and mortality following perforated peptic ulcer (PPU) remain substantial. Surgical delay is a well established negative prognostic factor, but evidence derives from studies with a high risk of bias. The aim of the present nationwide cohort study was to evaluate the adjusted effect of hourly surgical delay on survival after PPU.
This was a cohort study including all Danish patients treated surgically for PPU between 1 February 2003 and 31 August 2009. Medically treated patients and those with a malignant ulcer were excluded. The associations between surgical delay and 30-day survival are presented as crude and adjusted relative risks (RRs) with 95 per cent confidence intervals (c.i.).
A total of 2668 patients were included. Their median age was 70·9 (range 16·2-104·2) years and 55·4 per cent (1478 of 2668) were female. Some 67·5 per cent of the patients (1800 of 2668) had at least one of six co-morbid diseases and 45·6 per cent had an American Society of Anesthesiologists fitness grade of III or more. A total of 708 patients (26·5 per cent) died within 30 days of surgery. Every hour of delay from admission to surgery was associated with an adjusted 2·4 per cent decreased probability of survival compared with the previous hour (adjusted RR 1·024, 95 per cent c.i. 1·011 to 1·037).
Limiting surgical delay in patients with PPU seems of paramount importance.
穿孔性消化性溃疡（PPU）患者的发病率和死亡率仍然很高。手术延迟是一个公认的预后不良因素，但这些证据来源于存在高偏倚风险的研究。本项全国性队列研究的目的是评估 PPU 患者的手术延迟每小时与生存的调整后效应。
这是一项队列研究，纳入了 2003 年 2 月 1 日至 2009 年 8 月 31 日期间丹麦所有接受手术治疗的 PPU 患者。排除了接受药物治疗的患者和恶性溃疡患者。研究中以未调整和调整后的相对风险（RR）及其 95%置信区间（c.i.）呈现手术延迟与 30 天生存率之间的关联。
共纳入 2668 例患者，其年龄中位数为 70.9 岁（范围 16.2-104.2 岁），55.4%（1478/2668）为女性。67.5%（1800/2668）的患者至少存在六种合并疾病中的一种，45.6%的患者美国麻醉医师协会（ASA）体能分级为 III 级或更高。共有 708 例患者（26.5%）在手术后 30 天内死亡。与前 1 小时相比，从入院到手术的每小时延迟与调整后生存率降低 2.4%相关（调整后的 RR 1.024，95%c.i. 1.011 至 1.037）。
限制 PPU 患者的手术延迟似乎至关重要。
