title: Preoperative factors influencing mortality and morbidity in peptic ulcer perforation.
abstract: OBJECTIVE
  Perforated peptic ulcer is one of the most common surgical emergencies worldwide. With the improvement in medical therapy for peptic ulcers, the number of elective surgical procedures has come down. However, the incidence of perforated peptic ulcer is still increasing and remains as a substantial health problem with significant postoperative morbidity and mortality. This study aimed to find out the association between various preoperative and intraoperative factors with the postoperative mortality and morbidity in patients operated for peptic ulcer perforation.
  
  
  METHODS
  This prospective observational study had a time based sample of 101 perforation peritonitis cases admitted to the surgical wards of a tertiary care center from February 2015 to January 2016 who underwent laparotomy, diagnosed to have peptic ulcer perforation and underwent simple closure with an omental patch. Data regarding age, gender, presenting complaints, time elapsed from the onset of symptoms to surgery, physical examination findings, comorbid diseases, laboratory and imaging findings, intraoperative findings, length of hospital stay, postoperative morbidity, and mortality were recorded and analyzed.
  
  
  RESULTS
  Female gender, older age group, perforation surgery interval more than 36 h, and size of perforation more than 1 cm2were found to be significant factors influencing postoperative mortality and morbidity. Postoperative morbidity was also associated with comorbid diseases. Abnormal renal function on presentation was identified as an additional risk factor for postoperative morbidity and longer hospital stay.
  
  
  CONCLUSIONS
  An understanding of these factors, identification of patients at risk and early intervention can help in reducing the postoperative morbidity and mortality in peptic ulcer perforation.
authors.affiliation: Department of General Surgery, Government Medical College, Thiruvananthapuram, 695011, India. sivrm.p@gmail.com.
authors.forename: P
authors.identifier: http://orcid.org/0000-0001-5648-0873
authors.initials: P
authors.lastname: Sivaram
authors.affiliation: Department of General Surgery, Government Medical College, Thiruvananthapuram, 695011, India.
authors.forename: A
authors.initials: A
authors.lastname: Sreekumar
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications; D057234:Preoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Mortality—morbidity—peptic ulcer perforation; Peptic ulcer; Peptic ulcer perforation; Perforation peritonitis