Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation

TY - JOUR

T1 - Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation

AU - Møller, M H

AU - Adamsen, S

AU - Thomsen, R W

AU - Møller, A M

AU - Peptic Ulcer Perforation (PULP) trial group

AU - Jørgensen, Lars Nannestad

N1 - Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Background: Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU. Methods: This was an externally controlled multicentre trial set in seven gastrointestinal departments in Denmark. Consecutive patients who underwent surgery for gastric or duodenal PPU between 1 January 2008 and 31 December 2009 were treated according to a multimodal and multidisciplinary evidence-based perioperative care protocol. The 30-day mortality rate in this group was compared with rates in historical and concurrent national controls. Results: The 30-day mortality rate following PPU was 17.1 per cent in the intervention group, compared with 27.0 per cent in the three control groups (P = 0.005). This corresponded to a relative risk of 0.63 (95 per cent confidence interval 0.41 to 0.97), a relative risk reduction of 37 (5 to 58) per cent and a number needed to treat of 10 (6 to 38). Conclusion: The 30-day mortality rate in patients with PPU was reduced by more than one-third after the implementation of a multimodal and multidisciplinary perioperative care protocol, compared with conventional treatment.

AB - Background: Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU. Methods: This was an externally controlled multicentre trial set in seven gastrointestinal departments in Denmark. Consecutive patients who underwent surgery for gastric or duodenal PPU between 1 January 2008 and 31 December 2009 were treated according to a multimodal and multidisciplinary evidence-based perioperative care protocol. The 30-day mortality rate in this group was compared with rates in historical and concurrent national controls. Results: The 30-day mortality rate following PPU was 17.1 per cent in the intervention group, compared with 27.0 per cent in the three control groups (P = 0.005). This corresponded to a relative risk of 0.63 (95 per cent confidence interval 0.41 to 0.97), a relative risk reduction of 37 (5 to 58) per cent and a number needed to treat of 10 (6 to 38). Conclusion: The 30-day mortality rate in patients with PPU was reduced by more than one-third after the implementation of a multimodal and multidisciplinary perioperative care protocol, compared with conventional treatment.

U2 - 10.1002/bjs.7429

DO - 10.1002/bjs.7429

M3 - Journal article

C2 - 21442610

SN - 0007-1323

VL - 98

SP - 802

EP - 810

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 6

ER -