title: Adverse effects of delayed treatment for perforated peptic ulcer.
abstract: OBJECTIVE
  The authors assessed the consequences of delayed treatment for ulcer perforation with regard to short-term and long-term survival, complication rates, and length of hospital stay.
  
  
  BACKGROUND
  Important adverse effects of delayed treatment have not been studied previously. Conflicting results have been given with regard to short-term survival.
  
  
  METHODS
  One thousand two hundred ninety-two patients operated on for perforated peptic ulcer in the Bergen area between 1935 and 1990 were studied. The effect of delay on postoperative lethality and complications adjusted for age, sex, ulcer site, and year of perforation was analyzed by stepwise logistic regression. The effect of delay on duration of hospital stay adjusted for potential confounding factors was analyzed by Cox proportional hazards regression. Observed survival was estimated by the Kaplan-Meier method, and expected survival was calculated from population mortality data.
  
  
  RESULTS
  Adverse effects increased markedly when delay exceeded 12 hours. Delay of more than 24 hours increased lethality sevenfold to eightfold, complication rate to threefold, and length of hospital stay to twofold, compared with delay of 6 hours or less. The reduced long-term survival for patients treated more than 12 hours after perforation could be attributed entirely to high postoperative mortality.
  
  
  CONCLUSIONS
  Delayed treatment after peptic ulcer perforation reduced survival, increased complication rates, and caused prolonged hospital stay. To improve outcome after ulcer perforation, an effort should be made to keep delay at less 12 hours, particularly in elderly patients.
authors.affiliation: Department of Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: C
authors.initials: C
authors.lastname: Svanes
authors.forename: R T
authors.initials: RT
authors.lastname: Lie
authors.forename: K
authors.initials: K
authors.lastname: Svanes
authors.forename: S A
authors.initials: SA
authors.lastname: Lie
authors.forename: O
authors.initials: O
authors.lastname: Søreide
mesh_terms: D000367:Age Factors; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology; D002423:Cause of Death; D004381:Duodenal Ulcer / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D010439:Peptic Ulcer Perforation / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications* / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome