Perforated Gastroduodenal Ulcer: An Analysis of Risk Factors Related to Operative Mortality

Ryuichiro Suto, Yutaka Kuroda^*, Shigeki Nagayoshi, Mitsutaka Jinbo, Yasushi Kawazoe, Yuji Ikeda, Sumihiko Nawata, Satoru Kurata, Kiyoshi Nakayasu and Kensuke Esato

Department of Surgery, Yamaguchi Prefecture Hospital
Kuroda Clinic^*

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 patient'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.

Key words
gastroduodenal ulcer, perforation, mortality

Reprint requests
Ryuichiro Suto Department of Surgery, Yamaguchi Prefecture Hospital 77 Osaki, Hofu, 747-8511 JAPAN

Accepted
June 25, 2002

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