title: Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality.
abstract: BACKGROUND
  The purposes of this study were to determine clinical presentations and surgical outcomes of perforated peptic ulcer (PPU), and to evaluate the accuracy of the Boey scoring system in predicting mortality and morbidity.
  
  
  METHODS
  We carried out a retrospective study of patients undergoing emergency surgery for PPU between 2001 and 2006 in a university hospital. Clinical presentations and surgical outcomes were analyzed. Adjusted odds ratio (OR) of each Boey score on morbidity and mortality rate was compared with zero risk score. Receiver-operating characteristic curve analysis was used to compare the predictive ability between Boey score, American Society of Anesthesiologists (ASA) classification, and Mannheim Peritonitis Index (MPI).
  
  
  RESULTS
  The study included 152 patients with average age of 52 years (range: 15-88 years), and 78% were male. The most common site of PPU was the prepyloric region (74%). Primary closure and omental graft was the most common procedure performed. Overall mortality rate was 9% and the complication rate was 30%. The mortality rate increased progressively with increasing numbers of the Boey score: 1%, 8% (OR=2.4), 33% (OR=3.5), and 38% (OR=7.7) for 0, 1, 2, and 3 scores, respectively (p<0.001). The morbidity rates for 0, 1, 2, and 3 Boey scores were 11%, 47% (OR=2.9), 75% (OR=4.3), and 77% (OR=4.9), respectively (p<0.001). Boey score and ASA classification appeared to be better than MPI for predicting the poor surgical outcomes.
  
  
  CONCLUSIONS
  Perforated peptic ulcer is associated with high rates of mortality and morbidity. The Boey risk score serves as a simple and precise predictor for postoperative mortality and morbidity.
authors.affiliation: Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Prannok Road, Bangkok, 10700, Thailand. bolloon@hotmail.com
authors.forename: Varut
authors.initials: V
authors.lastname: Lohsiriwat
authors.forename: Siriluck
authors.initials: S
authors.lastname: Prapasrivorakul
authors.forename: Darin
authors.initials: D
authors.lastname: Lohsiriwat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult