PERFORATED GASTRIC AND DUODENAL-ULCER - AN ANALYSIS OF PROGNOSTIC FACTORS

A review of patients treated operatively for perforated ulcer was unde rtaken to determine factors that independently predict mortality and m orbidity. From 1980 to 1989 84 patients were treated with operative mo rtality and morbidity rates of 18 and 37 per cent, respectively. Patie nts with gastric ulcer were significantly older and were more likely t o have concomitant medical problems, to use steroids, and be hospitali zed at time of their perforation. They also had a higher perioperative mortality rate when compared to patients with gastroduodenal ulcers ( P < 0.05 for each). Patients treated with definitive operation (n = 51 ) had a significantly lower recurrent ulcer rate when compared to an e quivalent group treated with simple closure (n = 33) (mean follow-up, 47 months). Multivariate analysis confirmed a patient's likelihood of complication or death could be predicted using three variables (P < 0. 03); age greater than 42 years, hospitalization at time of perforation , concomitant medical illness. While the relative distribution of thes e three factors in patients with gastric versus peptic ulcers appears to account for the difference in outcome between these two groups, the distribution of these factors between patients treated with patch clo sure and definitive operation was not significantly different. Patient outcome from operation for perforated ulcer is dependent on preoperat ive conditions and appears to be independent of surgical procedure per formed. There was no benefit to simple closure of a perforated ulcer. Definitive procedures of perforated ulcers are associated with lower u lcer recurrence and therefore are advocated to treat perforation.