Title

Predictors of mortality in the elderly after open repair for perforated peptic ulcer disease

UMMS Affiliation

Department of Surgery; Department of Quantitative Health Sciences

Publication Date

2017-7

Document Type

Article

Disciplines

Clinical Epidemiology | Digestive System Diseases | Epidemiology | Geriatrics | Pathological Conditions, Signs and Symptoms | Surgery | Surgical Procedures, Operative | Translational Medical Research

Abstract

BACKGROUND: As the U.S. population ages and the number of emergent surgical repairs for perforated peptic ulcer disease (PUD) rise, contemporary national data evaluating operative outcomes for open surgical repair for perforated PUD among the elderly are lacking.

MATERIALS AND METHODS: The National Surgical Quality Improvement Program (2007-2014) was queried for patients > /=65 y who underwent open surgical repair for perforated PUD. The primary outcome was 30-d mortality. Secondary outcomes included 30-d postoperative complications. Univariate and multivariable regression analyses were performed.

RESULTS: Overall, 2131 patients underwent open surgical repair for perforated PUD. Among those who died, more used steroids preoperatively (15% versus 9%, P = 0.001) and fewer were independent preoperatively (55% versus 83%, P < 0.0001) compared to those who were alive 30-d postoperatively. Common postoperative complications were septic shock (15%) and pneumonia (12%). The overall 30-d mortality rate was 17.7%, with more deaths in subsequent decades of life (65-75 y 13% versus 75-84 y 18% versus > 85 y 24%, P < 0.0001). After adjustment for other factors, mortality was significantly associated with older age (85+ versus 65-74 y) (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.8, 1.7), dependent functional status preoperatively ([OR], 0.2; 95% CI, 0.2, 0.3), and American Society of Anesthesiologist classification > /=4 (OR, 3.2; 95% CI, 2.4, 4.3).

CONCLUSIONS: At U.S. hospitals, open surgical repair, the accepted treatment of perforated PUD, among the elderly is associated with significant 30-d morbidity and mortality rates that are unacceptably high in our contemporary era. Furthermore, mortality rates are associated with older age. Therefore, as the elderly population continues to increase in the United States, preoperative, perioperative, and postoperative measures must be taken to reduce this high morbidity and mortality rates.

Keywords

Elderly, Outcomes, Peptic ulcer disease, Surgical repair, UMCCTS funding

DOI of Published Version

10.1016/j.jss.2017.03.052

Source

J Surg Res. 2017 Jul;215:108-113. doi: 10.1016/j.jss.2017.03.052. Epub 2017 Apr 6. Link to article on publisher's site

Journal/Book/Conference Title

The Journal of surgical research

Related Resources

Link to Article in PubMed

PubMed ID

28688634

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