V. T. Daniel1, J. T. Wiseman1, J. Flahive1, H. P. Santry1 1University Of Massachusetts Medical School,Department Of Surgery,Worcester, MA, USA
Introduction: The management of perforated peptic ulcer disease (PUD) has drastically evolved over the last fifty years due to the advances in medical treatment. Despite medical management resulting in fewer elective surgical repairs, the number of emergent surgical repairs have risen. Furthermore, as the elderly population increases, the demographics of patients requiring emergency general surgery has shifted to an older cohort. Although hospitalizations for PUD are now among older adults compared to younger adults twenty years prior, contemporary national data evaluating operative outcomes for open surgical repair for perforated PUD among the elderly are lacking.
Methods: With use of the National Surgical Quality Improvement Program (2007-2012), patients 65 years and older who underwent open surgical repair for perforated PUD were evaluated. The primary outcome was 30-day mortality. Secondary outcomes were 30-day postoperative complications. Univariate and multivariable regression analyses were performed.
Results: Overall, 1422 patients 65 years and older underwent open surgical repair for perforated PUD. At the time of the operation, 19.3% were current or recent tobacco users and 9.2% required steroid use. Mean (± Standard Deviation) total hospital length of stay was 14 days (± 16). The most common postoperative complications were pneumonia (11.4%), septic shock (11%), and superficial site infection (5.1%) The overall 30-day mortality rate was 18.1%. After adjustment for other factors, 30-day mortality was significantly associated with postoperative pneumonia (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.48-4.98; P =.001), higher American Society of Anesthesiologists classification (OR, 2.59; 95% CI, 1.67-4.02; P <.0001), postoperative ventilator dependence (OR, 4.89; 95% CI, 2.91-8.14; P <.0001), and postoperative septic shock (OR, 5.07; 95% CI, 2.85-9.03; P < .0001).
Conclusions: At U.S. hospitals, open surgical repair for perforated PUD among the elderly is associated with significant 30-day morbidity and mortality rates. As the U.S. population ages, preoperative risk stratification strategies should focus more on the age of the patient given the high mortality rates among the elderly.