Surgery for perforated peptic ulcer in the elderly. Evaluation of factors influencing prognosis.
OBJECTIVE
The frequency of perforated peptic ulcer is decreasing among the overall population but it is becoming more frequent among old people. The higher mortality rate in the old population, justifies the search of prognostic factors specific for the elderly. Aim of this study is to analyze and define factors influencing surgical prognosis in patients older than 70 years who were operated for perforated peptic ulcer.


METHODS
A retrospective analysis of 37 patients was performed: age, sex, ASA status, site of perforation, diameter of perforation, duration of symptoms, MPI score, surgical treatment (suture vs. resection) were studied. All patients were grouped as deceased and not deceased after surgery: a statistical univariate analysis was performed regarding the whole series and regarding the patients 70 years and older.


RESULTS
Postoperative mortality rate was 18.92% in the whole series but 41.8% among the elderly. In the whole series age, ASA status, diameter of perforation, duration of symptoms, and MPI score were significantly related to postoperative death. In the patients 70 years and older the duration of symptoms, the size of perforation and the MPI score were significantly related to postoperative death.


CONCLUSIONS
The duration of symptoms is a known factor that influences the prognosis after surgery for perforated peptic ulcer. This factor is still the most important in the elderly being responsible of the high mortality rate. The delay in treatment is due to a delayed hospitalization of old patients, who show a low reactivity to the disease.
Uccheddu
Alessandro
A
Dipartimento Chirurgico Materno Infantile e di Scienza delle Immagini-Sezione di Semeiotica Chirurgica Università degli Studi di Cagliari, Italy. uccheddu@vaxca1.unica.it
Floris
Giulio
G
Altana
Maria Luisa
ML
Pisanu
Adolfo
A
Cois
Alessandro
A
Farci
Salvatore L
SL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004381:Duodenal Ulcer / Q000401:mortality / Q000601:surgery*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000401:mortality / Q000601:surgery*; D010538:Peritonitis / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D013276:Stomach Ulcer / Q000601:surgery*; D015996:Survival Rate