title: Low serum albumin may predict the need for gastric resection in patients with perforated peptic ulcer.
abstract: OBJECTIVE
  Perforated peptic ulcer (PPU) is a common surgical emergency and treatment involves omental patch repair (PR). Gastric resection (GR) is reserved for difficult pathologies. We audit the outcomes of GR at our institution and evaluate the pre-operative factors predicting the need for GR.
  
  
  METHODS
  This is a single-institution, retrospective study of patients with PPU who underwent surgery from 2004 to 2012. Demographics, clinical presentation and intra-operative findings were studied to identify factors predicting the need for GR in PPU. An audit of clinical outcomes and mortality for all patients with GR is reported.
  
  
  RESULTS
  537 (89.6 %) patients underwent PR and 62 (10.4 %) patients GR. Old age (p < 0.0001), female sex (p = 0.0123), non-steroidal anti-inflammatory drugs (NSAIDs) usage (p = 0.0008), previous history of peptic ulcer disease (PUD) (p = 0.0159), low hemoglobin (p < 0.0001), low serum albumin (p < 0.0001), high serum creatinine (p = 0.0030), high urea (p = 0.0006) and large ulcer size (p < 0.0001) predict the need for GR. On multivariate analysis only low serum albumin (OR 5.57, 95 % CI 1.56-19.84, p = 0.008) predicted the need for GR. The presence of Helicobacter pylori infection was protective against GR (OR 0.25, 95 %CI 0.14-0.44, p < 0.0001). Morbidity and mortality of GR was 27.7 and 24.2 %, respectively.
  
  
  CONCLUSIONS
  GR is needed in one in ten cases of PPU. Low serum albumin predicted the need for GR on multivariate analysis. Morbidity and mortality of GR remains high.
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore, Singapore.
authors.forename: J G
authors.initials: JG
authors.lastname: Seow
authors.affiliation: Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Y R
authors.initials: YR
authors.lastname: Lim
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore, Singapore. vgshelat@rediffmail.com.
authors.forename: V G
authors.initials: VG
authors.lastname: Shelat
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D003661:Decision Support Techniques; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D012846:Singapore / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012709:Serum Albumin
keywords: Albumin; Gastric resection; Perforated peptic ulcer