Surgical approach and prognostic factors after peptic ulcer perforation

Objective: To find out which prognostic factors were important in predictin g postoperative mortality and length of hospital stay in patients with perf orated peptic ulcers. Design: Retrospective study. Setting: Teaching hospital, Lund, Sweden. Subjects: 246 patients with perforated peptic ulcer who presented between J anuary 1974 and December 1992. Intervention: Cox proportional hazards analysis. Main outcome measures: Influence of age, sex, coexisting disease, duration of symptoms, site of perforation and operative technique on mortality and l ength of hospital stay. Results: Age over 75 years (p = 0.002), coexisting cardiac or pulmonary dis ease (p = 0.02), perforation of the cardia or body of the stomach (p = 0.02 ), lapse of more than 12 hours between start of symptoms and operation (p = 0.006) and type of operation (p < 0.0001) had a significant influence on h ospital mortality. Age over 75 years (p < 0.0001) and lapse of mon than 12 hours between start of symptoms and operation (p = 0.03) significant influe nced the likelihood of a prolonged stay in hospital. Conclusion: Patients with perforated peptic ulcers should be operated on as soon as possible. Simple closure is simple and safe with relatively low mo rtality and short stay in hospital.