[Preoperative delay in patients with peptic ulcer perforation: a clinical audit from the Danish National Indicator Project].
BACKGROUND
Mortality following perforated peptic ulcer in Denmark is nearly 30%. Delayed surgery is a prognostic factor, but only half of the patients are operated within six hours of perforation - a predefined quality of care criterion in The Danish National Indicator Project. A clinical audit was conducted to investigate possible reasons.


METHODS
All patients (n = 89) surgically treated for peptic ulcer perforation in six university hospitals in Denmark over a period of one year were included. The association between a number of predefined variables related to the internal organisation of health care, the patient's pathological picture and the quality of treatment given, and a preoperative delay of at least 6 hours was examined using modified Poisson regression analyses.


RESULTS
The following variables were associated with a preoperative delay = 6 hours: 1) out of hospital versus in hospital perforation (adjusted relative risk (RR) 1.87; 95% confidence interval (CI) 0.86-4.05), 2) no classical clinical symptoms of ulcer perforation (adjusted RR with peritonism 0.32; 95% CI 0.14-0.73), 3) first physician attendance later than median time, i.e. > 25 minutes after debut (adjusted RR 2.78; 95% CI 1.32-5.87), 4) first attendance not by senior physician (adjusted RR 1.97; 95% CI 0.95-4.05) and/or senior physician not called in (adjusted RR 2.53; 95% CI 1.12-5.75), and 5) oxygen saturation not monitored upon admission (adjusted RR 1.45; 95% CI 0.73-2.91).


CONCLUSIONS
Although of limited size, this audit suggests that long preoperative delay in patients with peptic ulcer perforation is associated with factors related to both the internal organisation of the healthcare system, the patient's pathological picture, and the quality of diagnosis and treatment given.
Møller
Morten Hylander
MH
Anaestesiologisk- og Intensiv Afdeling I-104, Herlev Hospital, DK-2730 Herlev, Denmark. mortenhylander@hotmail.com
Nørgård
Bente Mertz
BM
Mehnert
Frank
F
Bendix
Jørgen
J
Nielsen
Ann-Sophie
AS
Nakano
Anne
A
Adamsen
Sven
S
Thomsen
Reimar Wernich
RW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit; D002983:Clinical Competence; D057210:Delayed Diagnosis; D003718:Denmark / Q000453:epidemiology; D004381:Duodenal Ulcer / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D011379:Prognosis; D019984:Quality Indicators, Health Care; D013276:Stomach Ulcer / Q000150:complications* / Q000601:surgery; D013997:Time Factors