RISK-FACTORS INFLUENCING THE SHORT-TERM RESULTS OF GASTRODUODENAL PERFORATION

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 wer e retrospectively reviewed and the prognostic factors were examined. S even 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 12 h after perforation, in cases of preoperative sho ck and renal failure, and when associated with liver cirrhosis or an i mmunocompromised state. Tolerance to the time delay was inversely prop ortional 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. T hus, 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 r emains to be determined whether simpler procedures should be adopted f or high-risk patients.