Department of Surgery, University College London Hospitals, London, UK.
Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt.
Surg Endosc. 2024 Aug;38(8):4402-4414. doi: 10.1007/s00464-024-10881-0. Epub 2024 Jun 17.
There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these.
We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality.
1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality.
This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.
国际上关于穿孔性消化性溃疡（PPU）手术的发病率和死亡率的数据很少。本研究旨在了解全球范围内因 PPU 而行手术治疗的患者的 30 天发病率和死亡率，并确定与这些结果相关的变量。
我们对 2022 年 1 月 1 日至 2022 年 6 月 30 日期间因 PPU 而行手术治疗的成年患者（≥18 岁）进行了一项国际研究。排除接受保守治疗或患有潜在胃癌的患者。根据年龄（≤50 岁和>50 岁）和从症状发作到入院就诊的时间（≤24 小时和>24 小时），将患者分为亚组。进行单变量和多变量分析，以确定与 30 天发病率和死亡率较高相关的因素。
共纳入来自 52 个国家的 159 个中心的 1874 名患者。78.3%（n=1467）的患者为男性，中位（IQR）年龄为 49 岁（25）。30 天发病率和死亡率分别为 48.5%（n=910）和 9.3%（n=174）。中位（IQR）住院时间为 7（5）天。80%（n=1505）的患者接受了开放性手术。年龄>50 岁[比值比（OR）=1.7，95%置信区间（CI）1.4-2]，（OR=4.7，95%CI 3.1-7.6]），女性[OR=1.8，95%CI 1.4-2.3]，（OR=1.9，95%CI 1.3-2.9]），入院时休克[OR=2.1，95%CI 1.7-2.7]，（OR=4.8，95%CI 3.2-7.1]）和急性肾损伤[OR=2.5，95%CI 1.9-3.2]，（OR=3.9），95%CI 2.7-5.6）与 30 天发病率和死亡率均相关。延迟就诊与 30 天发病率相关[OR=1.3，95%CI 1.1-1.6]，但与死亡率无关。
本研究表明，PPU 手术与高 30 天发病率和死亡率相关。年龄、女性和入院时的休克表现与 30 天发病率和死亡率均相关。
