Long-term survival among patients operated upon for peptic ulcer disease

Background: Although surgery has been used widely for treating peptic ulcer disease, there is conflicting evidence with respect to subsequent life exp ectancy and the determinants of mortality. Our aim was to compare long-term survival in a large, population-based cohort of operated patients with tha t expected in the general population. Methods: We followed 471 Rochester, Minnesota residents who had surgery for peptic ulcer at the Mayo Clinic during 1956-85 for a total of 6174 person- years. Patients were followed through their complete (inpatient and outpati ent) medical records in the community until death or last clinical contact and death certificates were obtained for all who succumbed. We compared obs erved survival and cause-specific death rates in this cohort with expected values and identified the determinants of short (30 day) and long-term mort ality. Results and Conclusions: Survival was worse than expected, but excess death s were confined to those with perforated ulcers (42 deaths observed; 18.8 e xpected). Independent predictors of death included age, male gender, emerge ncy operation, gastric ulcer and cigarette smoking. Most deaths were due to heart disease and cancer, but only those due to digestive diseases (standa rdized mortality ratio (SMR) 3.8, 95% CI 2.4-5.7) and respiratory diseases (SMR 1.9, 95% CI 1.3-2.7) were increased compared to expected figures. Over all survival was reduced in this cohort but was normal among those whose ul cers were not perforated. However, the data suggest an adverse role for alc ohol and smoking in these patients. (C) 1999 Blackwell Science Asia Pty Ltd .