Surgical approach and prognostic factors after peptic ulcer perforation.

摘要

OBJECTIVE: To find out which prognostic factors were important in predicting postoperative mortality and length of hospital stay in patients with perforated peptic ulcers. DESIGN: Retrospective study. SETTING: Teaching hospital, Lund, Sweden. SUBJECTS: 246 patients with perforated peptic ulcer who presented between January 1974 and December 1992. INTERVENTION: Cox proportional hazards analysis. MAIN OUTCOME MEASURES: Influence of age, sex, coexisting disease, duration of symptoms, site of perforation and operative technique on mortality and length of hospital stay. RESULTS: Age over 75 years (p = 0.002), coexisting cardiac or pulmonary disease (p = 0.02), perforation of the cardia or body of the stomach (p = 0.02), lapse of more than 12 hours between start of symptoms and operation (p = 0.006) and type of operation (p < 0.0001) had a significant influence on hospital mortality. Age over 75 years (p < 0.0001) and lapse of more than 12 hours between start of symptoms and operation (p = 0.03) significant influenced the likelihood of a prolonged stay in hospital. CONCLUSION: Patients with perforated peptic ulcers should be operated on as soon as possible. Simple closure is simple and safe with relatively low mortality and short stay in hospital.