Abstract
Background: A perforation is a serious, potentially fatal complication of gastroduodenal ulcers. The incidence of perforated gastroduodenal ulcers has not decreased, althoughugh evidence shows a decrease in the surgery for gastroduodenal ulcers after an H2-receptor blocker is used. We studied risk factors related to operative mortality in perforated gastroduodenal ulcer patients. Methodology: From January 1983 to August 2001, 92 patients with perforated gastroduodenal ulcers underwent emergency surgery at our clinic. We studied; performance status (PS), medical illness, preoperative risk factor, surgical procedure, and postoperative morbidity. Results: Factors correlating significantly with mortality were age (p=0.0036), PS (p<0.0001). perforation size (p=0.0008), the time from onset to operastion (p=0.016), severe preoperative complication in either the liver (p=0.0008) or kidney (p<0.0001), and active malignancy (p=0.0059). Mortality in patients with postoperative complications such as anastomotic leakage (p<0.0001) or bleeding inthe gastrointestinal tract (p=0.0008) was significantly high. No significant correlation was seen between mortality and surgical procedure. Multivariate analysis indicated that a patientk's likelihood of death could be predicted using 5 variables: preoperative risk factor, postoperative anastomotic leakage/bleeding in the gastrointestinal tract, PS, perforation size, and the time from perforation to operation. A significant correlation was also seen between preoperative condition and postoperative anastomotic leakage/bleeding the the gastrointestinal tract. Patients outcome after operation for a perforated ulcer thus depends on preoperative condition of the patient and appears to be independent of surgical procedures.
