title: Perforated peptic ulcer: is there a difference between Eastern Europe and Germany? Copernicus Study Group and Acute Abdominal Pain Study Group.
abstract: OBJECTIVE
  Ulcer surgery and the epidemiology of peptic ulcer perforation have changed considerably in recent decades.
  
  
  METHODS
  Within two prospective studies, 170 perforated peptic ulcer patients from 12 Eastern European centres and 37 patients from 11 German centres were analysed.
  
  
  RESULTS
  The median age of patients was 43 years in the Copernicus study and 49 years in the MEDWIS study (P=n.s.), being higher for MEDWIS female patients (73 vs 53 years, respectively; P<0.05). Female patients made up 17% (29/170) of the Copernicus study and 35% (40/170) of the MEDWIS study (P<0.05). Twenty-three per cent (40/170) of patients in the Copernicus study and 54% (20/37) in the MEDWIS study had gastric ulcer perforation (P<0.001). The proportion of definitive operations was higher in Eastern Europe (41.1%; 67/163) than it was in Germany (16.1%; 5/31) (P<0.01). German patients experienced more general complications than Eastern European patients (35 vs 12%, respectively; P<0.01) and a higher mortality [13% (5/37) vs 2% (4/170), respectively; P<0.01]. Delayed admission > or =12 h and age > or =60 years remained predictors for complications in multivariate logistic regression analysis.
  
  
  CONCLUSIONS
  The proportion of both women and gastric ulcers was higher among German patients, while Eastern European patients underwent more definitive operations. German patients experienced more general complications and a higher mortality. Complications were related to high age and delayed admission.
authors.affiliation: Department of Surgery, University of Tartu, Estonia. Toomas.Sillakivi@kliinikum.ee
authors.forename: T
authors.initials: T
authors.lastname: Sillakivi
authors.forename: Q
authors.initials: Q
authors.lastname: Yang
authors.forename: A
authors.initials: A
authors.lastname: Peetsalu
authors.forename: C
authors.initials: C
authors.lastname: Ohmann
mesh_terms: D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D001317:Austria / Q000453:epidemiology; D004381:Duodenal Ulcer / Q000453:epidemiology / Q000601:surgery; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D017678:Sex Distribution; D013276:Stomach Ulcer / Q000453:epidemiology / Q000601:surgery; D015996:Survival Rate