title: Risk factors for reintervention after surgery for perforated gastroduodenal ulcer.
abstract: BACKGROUND
  Perforated gastroduodenal ulcer carries a high mortality rate. Need for reintervention after surgical repair is associated with worse outcome, but knowledge on risk factors for reintervention is limited. The aim was to identify prognostic risk factors for reintervention after perforated gastroduodenal ulcer in a nationwide cohort.
  
  
  METHODS
  All patients treated surgically for perforated gastroduodenal ulcer in Denmark between 2003 and 2014 were included using data from the Danish Clinical Register of Emergency Surgery. Potential risk factors for reintervention were assessed, and their crude and adjusted associations calculated by the competing risks subdistribution hazards approach.
  
  
  RESULTS
  A total of 4086 patients underwent surgery for perforated gastroduodenal ulcer during the study interval. Median age was 71·1 (i.q.r. 59·6-81·0) years and the overall 90-day mortality rate was 30·8 per cent (1258 of 4086). Independent risk factors for reintervention were: male sex (adjusted hazard ratio (HR) 1·46, 95 per cent c.i. 1·20 to 1·78), in-hospital perforation (adjusted HR 1·36, 1·11 to 1·68), high BMI (adjusted HR 1·49, 1·10 to 2·01), high ASA physical status grade (adjusted HR 1·54, 1·23 to 1·94), shock on admission (adjusted HR 1·40, 1·13 to 1·74), surgical delay (adjusted HR 1·07, 1·02 to 1·14) and other co-morbidity (adjusted HR 1·24, 1·02 to 1·51). Preadmission use of steroids (adjusted HR 0·59, 0·41 to 0·84) and age above 70 years (adjusted HR 0·72, 0·59 to 0·89) were associated with a reduced risk of reoperation.
  
  
  CONCLUSIONS
  Obese men with coexisting diseases and high disease severity who have surgery for gastroduodenal perforation are at increased risk of reoperation.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Hvidovre, Denmark. runehasselager@gmail.com.
authors.forename: R B
authors.identifier: http://orcid.org/0000-0003-0384-2521
authors.initials: RB
authors.lastname: Hasselager
authors.affiliation: Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Hvidovre, Denmark.|Department of Anaesthesia, Centre of Head and Orthopaedics 4231, Copenhagen, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Lohse
authors.affiliation: Department of Anaesthesiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Duch
authors.affiliation: Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: M H
authors.initials: MH
authors.lastname: Møller
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D004381:Duodenal Ulcer / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000401:mortality; D010439:Peptic Ulcer Perforation / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D018401:Sample Size; D013256:Steroids / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D013256:Steroids