Risk factors influencing the short-term results of gastroduodenal perforation

Abstract

The purpose of this study was to evaluate the risk factors influencing the short-term results of gastroduodenal perforation to determine the optimal treatment for reducing mortality. A total of 136 patients were retrospectively reviewed and the prognostic factors were examined. Seven patients died within 30 days, with an overall mortality rate of 5.1%. Mortality was significantly worse in those aged 50 years or more, when the leukocyte count was less than 9,500/mm3, when treatment was delayed more than 12h after perforation, in cases of preoperative shock and renal failure, and when associated with liver cirrhosis or an immunocompromised state. Tolerance to the time delay was inversely proportional to age, while the deaths in patients aged 65 years or younger were related to serious concurrent diseases. Shock and renal failure occurred most often in elderly patients as a result of delayed surgery, and the leukocyte count was an age-dependent prognostic indicator. Thus, age, the time interval between perforation and treatment, serious concurrent disease, shock, and renal failure were presumed to be the most important prognostic factors. Although definitive operations were performed on low-risk patients with an acceptably low mortality, it remains to be determined whether simpler procedures should be adopted for high-risk patients.

Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer

“…Such apparent discrepancies might be explained by the characteristics of patients included in the study, and/or by different age or different surgical procedures [16,18] . This study confirmed the previous observations [5,8,15,[25][26][27][28] that shock on admission and delayed operation were both associated with a greater mortality rate.…”

Community acquired secondary bacterial peritonitis in a tertiary hospital of South India: an audit with special reference to peritoneal fluid culture

“…Preoperative organ dysfunction or concomitant medical illness has been shown to be associated with increased mortality. [19][20][21][22] There was relatively higher incidence of renal failure in our study which is different from other series where cardiovascular, pulmonary and malignant conditions comprised of the major co-morbid conditions. Our study population was considered homogenous with regards to surgical treatment, with standard source control surgeries with peritoneal lavage with saline solution and drains based on the degree of peritoneal contamination.…”

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

“…The presence of subdiaphragmatic free air did not have a statistically significant relationship with mortality or morbidity. Wakayama et al (18) reported WBC counts below 9500/mm 3 was a significant predictor of mortalityHowever, no significant effect of WBC count on mortality or morbidity was observed in our study.…”