Perforated peptic ulcer: is there a difference between Eastern Europe and Germany?

Background and aims: Ulcer surgery and the epidemiology of peptic ulcer per foration have changed considerably in recent decades. Patients/Methods: Wit hin two prospective studies, 170 perforated peptic ulcer patients from 12 E astern European centres and 37 patients from 11 German centres were analyse d. Results: The median age of patients was 43 years in the Copernicus study and 49 years in the MEDWIS stud; (P=n.s.). being higher for MEDWIS female patients (73 vs 53 years, respectively; P<0.05). Female patients made up 17 % (29/170) of the Copernicus study and 35% (40/170) of the MEDWIS study (P< 0.05). Twenty-three per cent (40/170) of patients in the Copernicus study a nd 54% (20/37) in the MEDWIS study had gastric ulcer perforation (P<0.001) The proportion of definitive operations was higher in Eastern Europe (41.1% : 67/163) than it was in Germany (16.1%; 5/31) (P<0.01). German patients ex perienced more general complications than Eastern European patients (35 vs 12%, respectively; P<0.01 and a higher mortality [13% (5/37) vs 2% (4/170), respectively: P<0.01]. Delayed admission greater than or equal to 12 h and age greater than or equal to 60 years remained predictors for complication s in multivariate logistic regression analysis. Conclusion: The proportion of both women and gastric ulcers was higher among German patients, while Ea stern European patients underwent mon definitive operations. German patient s experienced more general complications and a higher mortality. Complicati ons were related to high age and delayed admission.