Risk factors in patients surgically treated for peptic ulcer perforation

Morten Hylander Møller; Kamran Shah; Jørgen Bendix; Anders Gadegaard Jensen; Erik Zimmermann-Nielsen; Sven Adamsen; Ann Merete Møller; Morten Hylander Møller; Kamran Shah; Jørgen Bendix; Anders Gadegaard Jensen; Erik Zimmermann-Nielsen; Sven Adamsen; Ann Merete Møller

doi:10.1080/00365520802401261

Risk factors in patients surgically treated for peptic ulcer perforation

Morten Hylander Møller, Kamran Shah, Jørgen Bendix, Anders Gadegaard Jensen, Erik Zimmermann-Nielsen, Sven Adamsen, Ann Merete Møller, Morten Hylander Møller, Kamran Shah, Jørgen Bendix, Anders Gadegaard Jensen, Erik Zimmermann-Nielsen, Sven Adamsen, Ann Merete Møller

32 Citations (Scopus)

Abstract

OBJECTIVE: The overall mortality for patients undergoing surgery for perforated peptic ulcer has increased despite improvements in perioperative monitoring and treatment. The objective of this study was to identify and describe perioperative risk factors in order to identify ways of optimizing the treatment and to improve the outcome of patients with perforated peptic ulcer. MATERIAL AND METHODS: Three hundred and ninety-eight patients undergoing emergency surgery in four university hospitals in Denmark were included in the study. Information regarding the pre-, intra- and postoperative phases were recorded retrospectively from medical records. Data were analysed using multiple logistic regression analysis. The primary end-point was 30-day mortality. RESULTS: The 30-day mortality rate was 27%. The following variables were independently associated with death within 30 days of surgery: ASA (American Society of Anaesthesiologists) class, age, shock upon admission, preoperative metabolic acidosis, elevated concentration of creatinine upon admission, subnormal concentration of albumin upon admission and insufficient postoperative nutrition. CONCLUSIONS: Thus, preoperative metabolic acidosis, renal insufficiency upon admission and insufficient postoperative nutrition have been added to the list of independent risk factors for death within 30 days of surgery in patients with peptic ulcer perforation. Finding that shock upon admission, reduced albumin blood levels upon admission, renal insufficiency upon admission and preoperative metabolic acidosis are independently related to 30-day mortality could indicate that patients with peptic ulcer perforation are septic upon admission, and thus might benefit from a perioperative care protocol with early source control and early goal-directed therapy according to The Surviving Sepsis Campaign. This hypothesis should be addressed in future studies.

Original language	English
Journal	Scandinavian Journal of Gastroenterology
Volume	44
Issue number	2
Pages (from-to)	145-52, 2 p following 152
ISSN	0036-5521
DOIs	https://doi.org/10.1080/00365520802401261 https://doi.org/10.1080/00365520802401261
Publication status	Published - 1 Jan 2009

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Møller, M. H., Shah, K., Bendix, J., Jensen, A. G., Zimmermann-Nielsen, E., Adamsen, S., Møller, A. M., Møller, M. H., Shah, K., Bendix, J., Jensen, A. G., Zimmermann-Nielsen, E., Adamsen, S., & Møller, A. M. (2009). Risk factors in patients surgically treated for peptic ulcer perforation. Scandinavian Journal of Gastroenterology, 44(2), 145-52, 2 p following 152. https://doi.org/10.1080/00365520802401261, https://doi.org/10.1080/00365520802401261

Møller, MH, Shah, K, Bendix, J, Jensen, AG, Zimmermann-Nielsen, E, Adamsen, S, Møller, AM, Møller, MH, Shah, K, Bendix, J, Jensen, AG, Zimmermann-Nielsen, E, Adamsen, S & Møller, AM 2009, 'Risk factors in patients surgically treated for peptic ulcer perforation', Scandinavian Journal of Gastroenterology, vol. 44, no. 2, pp. 145-52, 2 p following 152. https://doi.org/10.1080/00365520802401261, https://doi.org/10.1080/00365520802401261

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title = "Risk factors in patients surgically treated for peptic ulcer perforation",

abstract = "OBJECTIVE: The overall mortality for patients undergoing surgery for perforated peptic ulcer has increased despite improvements in perioperative monitoring and treatment. The objective of this study was to identify and describe perioperative risk factors in order to identify ways of optimizing the treatment and to improve the outcome of patients with perforated peptic ulcer. MATERIAL AND METHODS: Three hundred and ninety-eight patients undergoing emergency surgery in four university hospitals in Denmark were included in the study. Information regarding the pre-, intra- and postoperative phases were recorded retrospectively from medical records. Data were analysed using multiple logistic regression analysis. The primary end-point was 30-day mortality. RESULTS: The 30-day mortality rate was 27%. The following variables were independently associated with death within 30 days of surgery: ASA (American Society of Anaesthesiologists) class, age, shock upon admission, preoperative metabolic acidosis, elevated concentration of creatinine upon admission, subnormal concentration of albumin upon admission and insufficient postoperative nutrition. CONCLUSIONS: Thus, preoperative metabolic acidosis, renal insufficiency upon admission and insufficient postoperative nutrition have been added to the list of independent risk factors for death within 30 days of surgery in patients with peptic ulcer perforation. Finding that shock upon admission, reduced albumin blood levels upon admission, renal insufficiency upon admission and preoperative metabolic acidosis are independently related to 30-day mortality could indicate that patients with peptic ulcer perforation are septic upon admission, and thus might benefit from a perioperative care protocol with early source control and early goal-directed therapy according to The Surviving Sepsis Campaign. This hypothesis should be addressed in future studies.",

author = "M{\o}ller, {Morten Hylander} and Kamran Shah and J{\o}rgen Bendix and Jensen, {Anders Gadegaard} and Erik Zimmermann-Nielsen and Sven Adamsen and M{\o}ller, {Ann Merete} and M{\o}ller, {Morten Hylander} and Kamran Shah and J{\o}rgen Bendix and Jensen, {Anders Gadegaard} and Erik Zimmermann-Nielsen and Sven Adamsen and M{\o}ller, {Ann Merete}",

note = "Keywords: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Peptic Ulcer Perforation; Perioperative Care; Postoperative Complications; Risk Factors; Treatment Outcome Times Cited: 1ArticleEnglishMoller, M. HUniv Copenhagen, Herlev Hosp, Dept Anaesthesiol & Intens Care Med, Herlev Ringvej 75, DK-2730 Herlev, DenmarkCited References Count: 40397DZTAYLOR & FRANCIS ASKARL JOHANS GATE 5, NO-0154 OSLO, NORWAYOSLO",

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doi = "10.1080/00365520802401261",

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TY - JOUR

T1 - Risk factors in patients surgically treated for peptic ulcer perforation

AU - Møller, Morten Hylander

AU - Shah, Kamran

AU - Bendix, Jørgen

AU - Jensen, Anders Gadegaard

AU - Zimmermann-Nielsen, Erik

AU - Adamsen, Sven

AU - Møller, Ann Merete

AU - Møller, Morten Hylander

AU - Shah, Kamran

AU - Bendix, Jørgen

AU - Jensen, Anders Gadegaard

AU - Zimmermann-Nielsen, Erik

AU - Adamsen, Sven

AU - Møller, Ann Merete

N1 - Keywords: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Peptic Ulcer Perforation; Perioperative Care; Postoperative Complications; Risk Factors; Treatment Outcome Times Cited: 1ArticleEnglishMoller, M. HUniv Copenhagen, Herlev Hosp, Dept Anaesthesiol & Intens Care Med, Herlev Ringvej 75, DK-2730 Herlev, DenmarkCited References Count: 40397DZTAYLOR & FRANCIS ASKARL JOHANS GATE 5, NO-0154 OSLO, NORWAYOSLO

PY - 2009/1/1

Y1 - 2009/1/1

N2 - OBJECTIVE: The overall mortality for patients undergoing surgery for perforated peptic ulcer has increased despite improvements in perioperative monitoring and treatment. The objective of this study was to identify and describe perioperative risk factors in order to identify ways of optimizing the treatment and to improve the outcome of patients with perforated peptic ulcer. MATERIAL AND METHODS: Three hundred and ninety-eight patients undergoing emergency surgery in four university hospitals in Denmark were included in the study. Information regarding the pre-, intra- and postoperative phases were recorded retrospectively from medical records. Data were analysed using multiple logistic regression analysis. The primary end-point was 30-day mortality. RESULTS: The 30-day mortality rate was 27%. The following variables were independently associated with death within 30 days of surgery: ASA (American Society of Anaesthesiologists) class, age, shock upon admission, preoperative metabolic acidosis, elevated concentration of creatinine upon admission, subnormal concentration of albumin upon admission and insufficient postoperative nutrition. CONCLUSIONS: Thus, preoperative metabolic acidosis, renal insufficiency upon admission and insufficient postoperative nutrition have been added to the list of independent risk factors for death within 30 days of surgery in patients with peptic ulcer perforation. Finding that shock upon admission, reduced albumin blood levels upon admission, renal insufficiency upon admission and preoperative metabolic acidosis are independently related to 30-day mortality could indicate that patients with peptic ulcer perforation are septic upon admission, and thus might benefit from a perioperative care protocol with early source control and early goal-directed therapy according to The Surviving Sepsis Campaign. This hypothesis should be addressed in future studies.

AB - OBJECTIVE: The overall mortality for patients undergoing surgery for perforated peptic ulcer has increased despite improvements in perioperative monitoring and treatment. The objective of this study was to identify and describe perioperative risk factors in order to identify ways of optimizing the treatment and to improve the outcome of patients with perforated peptic ulcer. MATERIAL AND METHODS: Three hundred and ninety-eight patients undergoing emergency surgery in four university hospitals in Denmark were included in the study. Information regarding the pre-, intra- and postoperative phases were recorded retrospectively from medical records. Data were analysed using multiple logistic regression analysis. The primary end-point was 30-day mortality. RESULTS: The 30-day mortality rate was 27%. The following variables were independently associated with death within 30 days of surgery: ASA (American Society of Anaesthesiologists) class, age, shock upon admission, preoperative metabolic acidosis, elevated concentration of creatinine upon admission, subnormal concentration of albumin upon admission and insufficient postoperative nutrition. CONCLUSIONS: Thus, preoperative metabolic acidosis, renal insufficiency upon admission and insufficient postoperative nutrition have been added to the list of independent risk factors for death within 30 days of surgery in patients with peptic ulcer perforation. Finding that shock upon admission, reduced albumin blood levels upon admission, renal insufficiency upon admission and preoperative metabolic acidosis are independently related to 30-day mortality could indicate that patients with peptic ulcer perforation are septic upon admission, and thus might benefit from a perioperative care protocol with early source control and early goal-directed therapy according to The Surviving Sepsis Campaign. This hypothesis should be addressed in future studies.

U2 - 10.1080/00365520802401261

DO - 10.1080/00365520802401261

M3 - Journal article

SN - 0036-5521

VL - 44

SP - 145-52, 2 p following 152

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

IS - 2

ER -

Risk factors in patients surgically treated for peptic ulcer perforation

Abstract

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