title: Long-term mortality following peptic ulcer perforation in the PULP trial. A nationwide follow-up study.
abstract: OBJECTIVE
  Morbidity and mortality following perforated peptic ulcer (PPU) remain substantial. In the recently published PULP trial, 30-day mortality in patients surgically treated for PPU decreased from 27% to 17% following the implementation of a perioperative care protocol based on The Surviving Sepsis Guidelines. The objective of the present study was to evaluate long-term mortality in the PULP trial intervention and control cohort.
  
  
  METHODS
  
  
  
  METHODS
  nationwide follow-up study of a multicenter, non-randomized, clinical trial with external controls.
  
  
  METHODS
  Danish patients surgically treated for PPU between 1 January 2008 and 31 December 2009.
  
  
  METHODS
  117 patients in the intervention group and 512 in the control group.
  
  
  METHODS
  a perioperative care protocol based on The Surviving Sepsis Guidelines.
  
  
  METHODS
  60-day, 90-day, 180-day, 1-year, and 2-year mortality rates.
  
  
  METHODS
  survival statistics.
  
  
  RESULTS
  Baseline characteristics, clinical, and perioperative data were in general, similar in the intervention and control group. Sixty days postoperatively, the originally observed difference in 30-day mortality had diminished (25% vs. 30%, p = 0.268). After 180 days, the mortality difference was reduced additionally (31% vs. 33%, p = 0.645), and one year postoperatively, a mortality difference was no longer present (36% in both groups, p = 0.993). Two years postoperatively, the mortality rate in the intervention group was 44%, as compared to 40% in the control group (p = 0.472).
  
  
  CONCLUSIONS
  The survival benefit associated with a perioperative care protocol in patients treated for PPU decreases progressively after 30 days and is no longer present after one year.
  
  
  BACKGROUND
  NCT00624169 ( http://www.clinicaltrials.gov ).
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. mortenhylander@gmail.com
authors.forename: Morten Hylander
authors.initials: MH
authors.lastname: Møller
authors.forename: Morten
authors.initials: M
authors.lastname: Vester-Andersen
authors.forename: Reimar Wernich
authors.initials: RW
authors.lastname: Thomsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000401:mortality* / Q000601:surgery; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult