Incidence and Short-term Mortality From Perforated Peptic Ulcer in Korea: A Population-Based Study

Abstract

BackgroundPerforated peptic ulcer (PPU) is associated with serious health and economic outcomes. However, few studies have estimated the incidence and health outcomes of PPU using a nationally representative sample in Asia. We estimated age- and sex-specific incidence and short-term mortality from PPU among Koreans and investigated the risk factors for mortality associated with PPU development.MethodsA retrospective population-based study was conducted from 2006 through 2007 using the Korean National Health Insurance claims database. A diagnostic algorithm was derived and validated to identify PPU patients, and PPU incidence rates and 30-day mortality rates were determined.ResultsFrom 2006 through 2007, the PPU incidence rate per 100 000 population was 4.4; incidence among men (7.53) was approximately 6 times that among women (1.24). Incidence significantly increased with advanced age, especially among women older than 50 years. Among 4258 PPU patients, 135 (3.15%) died within 30 days of the PPU event. The 30-day mortality rate increased with advanced age and reached almost 20% for patients older than 80 years. The 30-day mortality rate was 10% for women and 2% for men. Older age, being female, and higher comorbidity were independently associated with 30-day mortality rate among PPU patients in Korea.ConclusionsSpecial attention should be paid to elderly women with high comorbidity who develop PPU.

Prognostic Factors in Peptic Ulcer Perforations: A Retrospective 14-Year Study

“…Despite our results, there are many studies suggesting that being female is a risk factor for PUP morbidities. 11,20,30 A higher mortality rate among women has also been observed in other studies. 20,26 However, we did not observe the sex variable to have any significant effect on mortality.…”

“…30,38 Alcohol consumption, smoking, and use of nonsteroidal anti-inflammatory drugs are strongly associated with PUD, but their effects on mortality and morbidity are in debate. 11,12,39 In the present study, alcohol consumption, smoking, usage of nonsteroidal antiinflammatory drugs had no significant effect on both mortality and morbidity. The effect of the site of the perforation is another controversial issue.…”

“…7,8 Morbidity was also high (20%-50%) in patients treated surgically for peptic ulcer perforations (PUPs). [9][10][11] The presence of gas under the diaphragm on plain abdominal erect X-ray is diagnostic in 75% of the cases. 12 In addition, having significant symptoms of PUP makes diagnosis easier.…”

“…13 The prognostic factors reported in the literature include delay in treatment, localization of perforation, age, being female, having coexisting medical problems, having a failed primary surgery, and gastrectomy. 11,12,[14][15][16] Currently, the American Society of Anesthesiologists (ASA) score and the Boey score are the most frequently used prognostic scoring systems in patients with PPU. 8,17,18 The aim of this study was to determine the factors affecting the mortality and morbidity of PUPs and describe the management of PUPs for better results.…”

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

“…High rates of morbidity (20%-50%) and mortality (3%-40%) have been reported for patients surgically treated for PUP (11)(12)(13)(14). There are many studies about the risk factors for these high mortality and morbidity rates.…”