Association of onset-to-surgery time with morbidity and mortality among patients with perforated peptic ulcer
TAN Kang-lian,LIANG Hai-long,GAI Juan-juan
Abstract:
Objective To compare the impact of early surgery and late surgery on the short-term prognosis of peptic ulcer perforation(PPU). Methods 217 patients with PPU at three hospitals from January 2019 to December 2021 were retrospectively reviewed. Patients’ clinical outcomes were compared between early surgery(ES，n=110) and late surgery(LS, n=107). The primary outcome was 30-day sepsis morbidity. Secondary outcomes included 30-day postoperative morbidity and 30-day mortality. Patients’ characteristics and surgical outcomes were also compared. Results Within 30 days after surgery, the incidence of sepsis in the ES group was 4.7%, while the incidence of sepsis in the LS group was as high as 21.5%. LS was associated with increased sepsis morbidity within 30 days(ORadj=5.71, 95% CI=2.02-16.10, P =0.001). In secondary analyses, LS was associated with an increased risk of postoperative morbidity(ORadj=1.93, 95% CI=1.06-3.53, P =0.032). The 30-day mortality rate was 0.9% in the ES group and 4.7% in the LS group(ORadj=3.93, 95% CI=0.43-36.05, P =0.227). In addition, the estimated blood loss during ES group was significantly less than that during LS group(P =0.004). The operative time and hospital stay were shorter in the ES group(P <0.005). Moreover, patients in the LS group were more likely to need for ICU admission(39.3% vs 22.7%, P =0.008). Conclusion More favorable outcomes were achieved when surgery was performed within 12 hours after the onset of severe abdominal pain among patients with PPU.
