Effectiveness of conservative treatment for upper gastrointestinal perforation in older patients aged >70 years: a single-center retrospective study

Abstract

Background Upper gastrointestinal perforation, primarily caused by peptic ulcers, remains a life-threatening condition associated with a high mortality rate. While surgical intervention has been the traditional first line of treatment, the establishment of various guidelines has prompted a shift in treatment strategies, particularly in cases of patients with mild symptoms of peritonitis who are aged < 70 years. The effectiveness of conservative treatment for upper gastrointestinal perforation in older patients remains unknown. Therefore, this study aimed to evaluate the effectiveness of conservative treatment by comparing it with that of surgical treatment in patients of the same age.Methods This retrospective study examined patients aged > 70 years with upper gastrointestinal perforation at Takeda General Hospital from April 2013 to March 2023. We focused on evaluating key factors such as duration of antibiotic use, blood transfusion requirements, fasting periods, length of hospital stay, discharge conditions, and mortality rates at 30- and 90-days post-treatment.Results The study included 31 patients (11 underwent conservative treatment and 20 underwent surgery). More patients had generalized peritonitis in the surgical group than in the conservative treatment group (p = 0.023). Regarding the course after intervention, the fasting period was slightly longer in the conservative treatment group than in the surgical group (p = 0.0064); however, no 30-day deaths were noted overall, with no significant difference in 90-day mortality between the two groups.Conclusions Conservative treatment for upper gastrointestinal perforation in older patients aged > 70 years, when appropriately selected, demonstrated outcomes equivalent to those of surgical intervention. Conservative treatment appears to be effective in cases of localized peritonitis, potentially avoiding unnecessary surgery. Further accumulation of case studies is desirable for establishment of clear criteria for conservative treatment indications in the older patients.