Risk factors of mortality in perforated peptic ulcer

Objective: To assess the risk factors that influence mortality from perforated peptic ulcer. Design: Retrospective study. Setting: General hospital, Taiwan. Subjects: 179 patients who had their perforated peptic ulcers operated on and who had minimum follow-up of one year. Main outcome measures: Mortality. Results: The overall mortality was 15% (26/179). Of the 26 patients who died, the cause of death was uncontrolled systemic infection in 21 (81%), hypovolaemic shock in 2, and fatal arrhythmia and heart failure in 1 each. 15 of the patients who died of sepsis did not have fulminant abdominal sepsis. Most deaths occurred early after operation, (range 1-96 days). Old age, preoperative shock, and type of operation seemed to be related to these deaths on univariate analysis, but multivariate analysis showed that coexisting medical illness, delayed treatment, and low albumin concentration were independent risk factors for mortality. Conclusions: To improve the result of treatment of perforated peptic ulcer, the diagnosis and treatment should not be delayed, the associated medical illnesses should be treated, and nutritional support should be given.