Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study

Abstract

ObjectivesThis study used national audit data to describe current management and outcomes of patients undergoing surgery for complications of peptic ulcer disease (PUD), including perforation and bleeding. It was also planned to explore factors associated with fatal outcome after surgery for perforated ulcers. These analyses were designed to provide a thorough understanding of current practice and identify potentially modifiable factors associated with outcome as targets for future quality improvement.DesignNational cohort study using National Emergency Laparotomy Audit (NELA) data.SettingEnglish and Welsh hospitals within the National Health Service.ParticipantsAdult patients admitted as an emergency with perforated or bleeding PUD between December 2013 and November 2015.InterventionsLaparotomy for bleeding or perforated peptic ulcer.Primary and secondary outcome measuresThe primary outcome was 60-day in-hospital mortality. Secondary outcomes included length of postoperative stay, readmission and reoperation rate.Results2444 and 382 procedures were performed for perforated and bleeding ulcers, respectively. In-hospital 60-day mortality rates were 287/2444 (11.7%, 95% CI 10.5% to 13.1%) for perforations, and 68/382 (17.8%, 95% CI 14.1% to 22.0%) for bleeding. Median (IQR) 2-year institutional volume was 12 (7–17) and 2 (1–3) for perforation and bleeding, respectively. In the exploratory analysis, age, American Society of Anesthesiology score and preoperative systolic blood pressure were associated with mortality, with no association with time from admission to operation, surgeon grade or operative approach.ConclusionsPatients undergoing surgery for complicated PUD face a high 60-day mortality risk. Exploratory analyses suggested fatal outcome was primarily associated with patient rather than provider care factors. Therefore, it may be challenging to reduce mortality rates further. NELA data provide important benchmarking for patient consent and has highlighted low institutional volume and high mortality rates after surgery for bleeding peptic ulcers as a target for future research and improvement.

Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years

“…Surgical repair with closure of the perforation, with or without an omental pedicle, is the preferred treatment for PPU[ 11 , 15 , 16 ]. This repair can be achieved through either open repair or laparoscopy[ 15 , 17 ].…”

A Large Stomach Ulcer Is Associated With Raised Mortality in a Cohort of Patients Who Underwent Open Repair of Perforated Peptic Ulcer: A Five-Year Follow-Up Study

“…With regard to the hospital length of stay stomach PPUD, large PPUD and ACCI score were associated with increase of hospital length of stay. These findings suggest that patients who have a large stomach PPUD might need careful perioperative and postoperative personalized surgical plans as these patients may eventually undergo complicated surgical procedures [3].…”

“…Several risk factors have a potential role in developing PPUD, including cigarette smoking, NSAID (nonsteroidal anti-inflammatory drug) use, Helicobacter pylori infection, and a history of previous PUD [1]. The postoperative complications are mainly related to patients' factors rather than in-hospital care [3]. However, these risk factors and their relation to morbidity and mortality rates are not well described in the literature.…”

Risk factors of perioperative mortality from complicated peptic ulcer disease in Africa: systematic review and meta-analysis

“…In a recent first national study in the UK of complicated PUD requiring emergency surgery found in-hospital 60-day mortality to be higher in patients with bleeding (17.8%) than in patients with perforated PUD (11.7%),16 and yet the vast majority of complicated PUD was perforation (86%). However, a recent European study reported 90-day mortality rates to be higher for perforated PUD at 29.8% than in bleeding PUD at 5.3% 17.…”