Peptik ülser perforasyonunda mortalite ile ilişkili faktörlerin değerlendirilmesi: Retrospektif vaka-kontrol çalışması

Abstract

Aim: Although there has been significant progress in current medical treatments for the treatment of peptic ulcer, there has been no change in the incidence of peptic ulcer perforation (PUP). PUP has an important place in urgent surgery due to mortality rates. In this study, it was aimed to determine the factors related to death related to PUP. Material and method: Observational type study was planned. Patients who underwent surgery due to PUP in 2009-2016 included to study. The number of samples was set at 225 to show 30% difference with a 5% α error at 90% safety interval. Twenty patients were added to reduce the error. Patients were screened for demographic data, presence of chronic disease (diabetes, cardiac), smoking status, nonsteroidal anti-inflammatory (NSAID) use, reference leukocyte level, complaint-to-intervention time and surgical site infection (SSI). The death in the perioperative period (first month) was determined as the main outcome parameter. Patients were divided into two groups according to the presence of death (Group 1: study group, Group 2: control group). Descriptive statistics, number, percentage, mean ± standard deviation, median (quartile range) were used for statistics. T-test, Mann-Whitney, Fisher's exact and Chi-square test were used for comparisons. A p value of less than 0.05 was considered significant at 95% safety interval. Results: 245 patients (group 1: 11 (4.5%), group 2: 234 (95.5%) were included in the study. The groups were divided into two groups according to sex (group 1: Male/Female=1,2, group 2: Male/Female=6,1) and age (group 1: 62,8±16,6, group 2: 40±16,8) The difference was detected (p=0.016, p=0.0001). Chronic cardiac diseases were more common in the study group (p=0.0001). There was no difference in the presence of diabetes, smoking, and NSAID use (p=0.092, p=0.624, p=0.214). Leukocyte levels were found to be low in the study group (group 1: 9 (10) thousand/mm3, group 2: 13 (6), p=0.032). Complaints-operation times were higher in the study group (group 1: 12 (14) hours, group 2: 4 (4), p=0.0001). All the patients were repaired by Graham Rapha and drained. The duration of post-operative stay was similar between the groups (group 1: 4 (5) days, group 2: 5 (2), p=0.443). SSI was more frequent in the study group (p=0.008). Conclusion: Patients with female gender, advanced age, and chronic heart disease should be more cautious due to the high mortality risk.