Factors affecting mortality in patients who underwent primary suture repair for peptic ulcer perforation

2 Işık et al., Peptic Ulcer Perforation / doi: 10.14744/hnhj.2017. 38257 on and the detection of subdiaphragmatic free air on direct radiograms; however, in older, immunocompromised patients, establishment of a diagnosis is not always possible [2]. Previously, advanced age, a delay in diagnosis, the presence of concomitant disease, failed primary surgery, and gastrectomy have been described as poor prognostic factors. In this study, the aim was to determine the factors affecting postoperative mortality in patients who underwent primary suturing for PUP repair. Materials and Methods The hospital database was screened for patients who underwent primary suture repair in the clinic between September 2009 and December 2016 with the indication of PUP. The files of 121 patients were retrospectively analyzed. Informed consent forms had been acquired from all of the patients for all medical treatments and interventions performed. The study protocol was designed in compliance with the Helsinki Declaration, and the patient data were anonymized. Since the data used in our study were obtained retrospectively from patient files, ethics committee approval was not requested. Patients aged >18 years who had undergone primary suture repair, with or without omentoplasty, with the indication of PUP were included in the study. Patients who underwent a gastrectomy (n=4) were not included. Patients with a tumoral perforation (n=8), those whose histopathological examination of intraoperative biopsy specimens revealed the presence of malignancy (n=4), and patients whose postoperative control endoscopy detected malignancy (n=2) were also excluded from the study. Demographic data, information regarding concomitant disease, laboratory findings, Boey score, admission details, operative data, hospital stay data, and the morbidity and mortality of the patients were evaluated. The admission period was calculated in days as beginning with the onset of symptoms until the time of surgery. Details of patients presenting with admission symptoms of shock or hypotension requiring inotropic support, respiratory distress requiring mechanical ventilation support, or acute renal failure, which may or may not have required hemodialysis can be seen in Table 1. The Boey scoring system is used to predict the prognosis of patients with PUP. The calculation evaluates the risk factors of time since perforation, the presence of preoperative shock, and concomitant disease [1]. The patients were divided into 2 groups based on survival, and the differences between those who survived and those who did not were assessed. JMP version 12 software (SAS Institute Inc., Cary, NC, USA) was used for the statistical analysis. Categorical variables were expressed as percentages, and continuous variables as mean±SD and median (min-max). In the analysis of categorical variables, a chi-square test and Fisher’s exact test were used, and the Wilcoxon signed-rank test was used for continuous variables. Conditional models for multivariate analysis of matched data were constructed to evaluate the factors affecting mortality. P<0.05 was accepted as the level of statistical significance.