FACTORS THAT PREDICT MORBIDITY AND MORTALITY IN PATIENTS WITH PERFORATED PEPTIC ULCERS
Dr. Halil COŞKUN, Dr. Özgür BOSTANCI, Dr. Uygar DEMİR, Dr. Ece DİLEGE, Dr. Mehmet MİHMANLI
Şişli Etfal Eğitim ve Araştırma Hastanesi 3. Genel Cerrahi Kliniği, İstanbul
In this study it is aimed to describe the risk factors predictive of mortality and morbidity in patients that underwent emergency surgery for peptic ulcer perforation.
Patients operated on for peptic ulcer perforation in 3. General Surgery Department of Şişli Etfal Training and Research Hospital between March 2001-June 2003 were analyzed prospectively. Using APACHE II scoring system, patients were divided into two groups. Patients with a score greater than five has been described as high-risk group. Also patients with comorbid conditions, delay to surgery (>24 hours) and ulcer perforation size (>1 cm) had been identified as other parameters.
There were 60 males (84.5%) and 11 females (15.5%) with a mean age 39.13 years (range 17-82). Nine patients had postoperative complications, including pneumonia (2 patients), evisceration (2 patients), intraabdominal abscess (2 patients), gastric leakage (2 patients) and cardiopulmonary failure (1 patient). According to APACHE II scoring system there were 11 patients in the high-risk group and 6 patients in this group had postoperative morbidity (p=0.000), 1 patient had mortality. Eleven patients had comormid conditions, 4 patients with comorbid conditions had postoperative morbidity (p=0.027). There were 13 patients with a delay of surgery 24 hours after onset of symptoms, and 4 patients in this group had morbidity (p=0.350). Ulcer size was greater than 1 cm in 7 patients and 5 of these had postoperative complications (p=0.000). 34 (47.8%) patients were over 40 years of age and 8 (23.5) of these patients had postoperative complications (p=0.011).
Evaluating patients who underwent emergency surgery for peptic ulcer perforation using by APACHE II scoring system additionally describing other risk factors (comorbid conditions, ulcer size, delay of surgery, age) gives a detailed documentation about morbidity rate and helps selecting the modality of surgical treatment.
Keywords: Peptic ulcer perforation, APACHE II, mortality, morbidity