title: Postoperative Morbidity and Mortality of Perforated Peptic Ulcer: Retrospective Cohort Study of Risk Factors among Black Africans in Côte d'Ivoire.
abstract: Introduction. Surgical treatment of perforated peptic ulcer (PPU) is a challenge for surgeons in Africa. Aim. To determine risk factors of postoperative complications or mortality among black Ivoirian patients with PPU. Methods. All 161 patients (median age = 34 years, 90.7 male) operated on for PPU in the visceral and general surgery unit were enrolled in a retrospective cohort study. Variables were studied with Kaplan Meier and Cox proportional hazard models. Results. Among 161 patients operated on for PPU, 36 (27.5%) experienced complications and 31 (19.3%) died. Follow-up results were the incidence of complications and mortality of 6.4 (95% CI: 4.9-8.0) per 100 person-days and 3.0 (95% CI: 1.9-4.0) per 100 person-days for incidence of mortality. In multivariate analysis, risk factors of postoperative complications or mortality were comorbidities (HR = 2.1, P = 0.03), tachycardia (pulse rate > 100/minutes) (HR = 2.4, P = 0.02), purulent intra-abdominal fluid collection (HR = 2.1, P = 0.04), hyponatremia (median value ≤ 134 mEq/L) (HR = 2.3, P = 0.01), delayed time of hospital admission > 72 hours (HR = 2.6, P < 0.0001), and delayed time of surgical intervention between 24 and 48 hours (HR = 3.8, P < 0.0001). Conclusion. The delayed hospital admission or surgical intervention and hyponatremia may be considered as additional risk of postoperative complications or mortality in Black African patients with PPU.
authors.affiliation: Service de Chirurgie Digestive et Viscérale, CHU de Yopougon, Côte d'Ivoire.
authors.forename: Soro Kountele
authors.initials: SK
authors.lastname: Gona
authors.affiliation: Service de Médecine et d'Hépato-Gastroentérologie, CHU de Yopougon, Côte d'Ivoire.
authors.forename: Mahassadi Kouamé
authors.identifier: 0000-0003-3625-6270
authors.initials: MK
authors.lastname: Alassan
authors.affiliation: Service de Chirurgie Digestive et Viscérale, CHU de Yopougon, Côte d'Ivoire.
authors.forename: Koffi Gnangoran
authors.initials: KG
authors.lastname: Marcellin
authors.affiliation: Service de Médecine et d'Hépato-Gastroentérologie, CHU de Yopougon, Côte d'Ivoire.
authors.forename: Kissi Ya
authors.identifier: 0000-0002-6656-1375
authors.initials: KY
authors.lastname: Henriette
authors.affiliation: Service de Chirurgie Digestive et Viscérale, CHU de Yopougon, Côte d'Ivoire.
authors.forename: Coulibaly
authors.initials: C
authors.lastname: Adama
authors.affiliation: Service de Chirurgie Digestive et Viscérale, CHU de Yopougon, Côte d'Ivoire.
authors.forename: Assohoun
authors.initials: A
authors.lastname: Toussaint
authors.affiliation: Service de Chirurgie Digestive et Viscérale, CHU de Yopougon, Côte d'Ivoire.
authors.forename: Ehua Adjoba
authors.initials: EA
authors.lastname: Manuela
authors.affiliation: Service de Chirurgie Digestive et Viscérale, CHU de Yopougon, Côte d'Ivoire.
authors.forename: Seu Gagon
authors.initials: SG
authors.lastname: Sylvain
authors.affiliation: Kumasi Centre of Collaborative Research in Tropical Medicine, Ghana.
authors.forename: Afum-Adjei Awuah
authors.initials: AA
authors.lastname: Anthony
authors.affiliation: Service des Urgences Médico-Chirurgicales, CHU de Yopougon, Côte d'Ivoire.
authors.forename: Ehua Somian
authors.initials: ES
authors.lastname: Francis