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Long-Term Mortality in Patients Operated for Perforated Peptic Ulcer: Factors Limiting Longevity are Dominated by Older Age, Comorbidity Burden and Severe Postoperative Complications

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Abstract

Background

Perforated peptic ulcer (PPU) is a surgical emergency associated with high short-term mortality. However, studies on long-term outcomes are scarce. Our aim was to investigate long-term survival after surgery for PPU.

Materials and Methods

A population-based, consecutive cohort of patients who underwent surgery for PPU between 2001 and 2014 was reviewed, and the long-term mortality was assessed. Survival was investigated by univariate analysis (log-rank test) and displayed using Kaplan–Meier survival curves. Multivariable analysis of risk factors for long-term mortality was assessed by Cox proportional hazards regression and reported as hazard ratio (HR) with 95 % confidence intervals (CI).

Results

A total of 234 patients were available for the calculation of ninety-day, one-year and two-year mortality, and the results showed rates of 19.2 % (45/234), 22.6 % (53/234) and 24.8 % (58/234), respectively. At the end of follow-up, a total of 109 of the 234 patients (46.6 %) had died. Excluding 37 (15.2 %) patients who died within 30 days of surgery, 197 patients had long-term follow-up (median 57 months, range 1–168) of which 36 % (71/197) died during the follow-up period. In multivariable analyses, age >60 years (HR 3.95, 95 % CI 1.81–8.65), active cancer (HR 3.49, 95 % CI 1.73–7.04), hypoalbuminemia (HR 1.65, 95 % CI 0.99–2.73), pulmonary disease (HR 2.06, 95 % CI 1.14–3.71), cardiovascular disease (HR 1.67, 95 % CI 1.01–2.79) and severe postoperative complications (HR 1.76, 95 % CI 1.07–2.89) during the initial stay for PPU were all independently associated with an increased risk of long-term mortality. Cause of long-term mortality was most frequently (18 of 71; 25 %) attributed to new onset sepsis and/or multiorgan failure.

Conclusion

The long-term mortality after surgery for PPU is high. One in every three patients died during follow-up. Older age, comorbidity and severe postoperative complications were risk factors for long-term mortality.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway

    K. Thorsen, J. A. Søreide & K. Søreide

  2. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    J. A. Søreide & K. Søreide

Authors
  1. K. Thorsen
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  2. J. A. Søreide
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  3. K. Søreide
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Corresponding author

Correspondence to K. Thorsen.

Appendix: ROC analysis of Charlson score for cutoff points

Appendix: ROC analysis of Charlson score for cutoff points

See Table 4.

Table 4 Coordinates of the curve: test result variable(s): Charlson score
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Thorsen, K., Søreide, J.A. & Søreide, K. Long-Term Mortality in Patients Operated for Perforated Peptic Ulcer: Factors Limiting Longevity are Dominated by Older Age, Comorbidity Burden and Severe Postoperative Complications. World J Surg 41, 410–418 (2017). https://doi.org/10.1007/s00268-016-3747-z

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