Study of Risk factors predicting increased morbidity and mortality in perforated peptic Ulcer-Our Institutional Perspective

Abstract

Background : Perforated Peptic Ulcer [PPU] is a common condition operated as emergency in almost all hospitals across the world. Due to availability of good antiulcer medications elective peptic ulcer operations has significantly reduced. But emergency operations for peptic ulcer perforations is still increasing with substantial health issues resulting in significant postoperative morbidity and mortality. Objective: To identify the risk factors Predicting Increased Morbidity and Mortality in perforated Peptic Ulcer. Methods: This is a retrospective study of 200 patients operated for peptic ulcer perforations between January 2015 to December 2020 done by the Department of General Surgery at Hassan institute of Medical Sciences Approval to use medical records and clearance certificate from human ethics committee, Hassan institute of medical sciences, Karnataka, India was obtained prior to the study. Demographic profile of patient, symptoms at presentation, time from onset of symptoms to admission to hospital, associated co-morbidities, laboratory and imaging findings, time delay from admission to surgery; hospital stay duration, postoperative complications and mortality were recorded. Results: Mean age of subjects in the study was 46.34 ± 15.9 years. Male: Female ratio was 11.5:1. In the study 42.5% had complications. 13.5% had wound infection, 22.5% had chest infection, 16% had renal failure, 10.5% had septic shock, 18.5% required ventilator and 3.5% required Relaparotomy. In the study there was significant association between Mortality and presence of morbidity,and renal failure, septic shock and needed ventilator. Conclusion: The present study concluded that Post Op stay (>2 Weeks),ASA grade(>2),Size of Perforation(>1 cm) were significant factors associated with Morbidity and Factors such as Female Gender, Presence of Comorbidity (COPD), Hypotension (Shock), Raised Serum Creatinine, Post Op stay (>2 Weeks) and presence of morbidities such as Renal failure, Septic Shock, Need for Ventilator were significantly associated with Mortality.