Perforated peptic ulcer: predictive factors of postoperative morbidity and mortality

Objective. To identify predictive factors of morbidity and mortality following perforated peptic ulcer (PPU). Material and methods. A retrospective study included patients with PPU who underwent surgery between 1 January 2012 and 30 June 2021. Results. A total of 129 patients were included. There were 114 men (88.4%) and 15 women (11.6%) with M/F ratio 7.6 and mean age 44.8 years (range 17—89). All patients underwent urgent surgical treatment. Laparoscopic approach was carried out in 90.7% of cases, median laparotomy — in 9.3% of cases. Intraoperative exploration revealed peritonitis in 123 cases. Perforation was located in anterior aspect of the duodenal bulb in 95.3% of patients and on the upper edge of the duodenal bulb in 4.7% of cases. Perforation suturing, peritoneal lavage and abdominal drainage were performed in all patients. Mean surgery time was 93 min. Conversion to laparotomy was performed in 6.2% of patients. Time to conversion ranged from 50 to 120 min. The overall morbidity rate was 7.8%, overall mortality rate — 7.8%. In multivariate analysis, morbidity and mortality risk factors were age >45 years, female gender, smoking, comorbidities, shock on admission, delay of surgery >6 hours, creatinine >106 μmol/L, degree of peritoneal contamination and perforation size. Conclusion. Analysis of predictive factors of morbidity and mortality in PPU is crucial to improve patient outcomes and guide clinical decision-making.