ADVERSE-EFFECTS OF DELAYED TREATMENT FOR PERFORATED PEPTIC-ULCER

Objective The authors assessed the consequences of delayed treatment f or ulcer perforation with regard to short-term and long-term survival, complication rates, and length of hospital stay. Summary Background D ata Important adverse effects of delayed treatment have not been studi ed previously. Conflicting results have been given with regard to shor t-term survival. Methods One thousand two hundred ninety-two patients operated on for perforated peptic ulcer in the Bergen area between 193 5 and 1990 were studied. The effect of delay on postoperative lethalit y and complications adjusted for age, sex, ulcer site, and year of per foration was analyzed by stepwise logistic regression. The effect of d elay on duration of hospital stay adjusted for potential confounding f actors was analyzed by Cox proportional hazards regression. Observed s urvival was estimated by the Kaplan-Meier method, and expected surviva l was calculated from population mortality data. Results Adverse effec ts increased markedly when delay exceeded 12 hours. Delay of more than 24 hours increased lethality sevenfold to eightfold, complication rat e to threefold, and length of hospital stay to twofold, compared with delay of 6 hours or less. The reduced long-term survival for patients treated more than 12 hours after perforation could be attributed entir ely to high postoperative mortality. Conclusions Delayed treatment aft er peptic ulcer perforation reduced survival, increased complication r ates, and caused prolonged hospital stay. To improve outcome after ulc er perforation, an effort should be made to keep delay at less 12 hour s, particularly in elderly patients.