R. Dev1, J. Mccauley1, T. Wyatt1, V. Natkha1, J. Luo3, Y. Zhang2,3, K. Y. Pei1 1Texas Tech University Health Sciences Center,Surgery,Lubbock, TX, USA 2Yale University School Of Medicine,Surgical Outcomes And Epidemiology,New Haven, CT, USA 3Yale School of Public Health,Environmental Health Sciences,New Haven, CT, USA
Introduction:
Decades after the introduction of acid reducers and the recognition of endemic helicobacter pylori infection as the cause of peptic ulcers, medical management has largely replaced surgical therapy. Nevertheless, a portion of patients will require operative intervention for perforated ulcers. With the increasing adoption of advance laparoscopic techniques, it is uncertain the practice patterns among US surgeons during the last decade. This study evaluates the trends and outcomes in management of perforated peptic ulcers.
Methods:
The ACS NSQIP database was queried for patients with diagnosis of peptic ulcer perforation (ICD 10 codes K26.5, K27.2, K26.1 K27.1, and K27.5 and ICD 9 codes 532.1, 532.5, 533.2, 533.5, 533.10)from 2005 to 2016. Only the index operation identified by the current procedural codes (CPT) was included for analysis. Based on CPT codes, operations were divided into 3 major groups including: simple open suture repair, laparoscopic repairs, and open suture repair open suture repair with omental patch). Trends and practice patterns were evaluated as percentages of total procedures performed from NSQIP participating hospitals. Standard descriptive statistics were analyzed using student t test and chi-squared as indicated. Outcomes including complications, mortality or reoperation were evaluated by procedural group.
Results:
A total of 2,603 procedures were included for analysis. There were no significant differences among patient characteristics between the 3 groups. Among NSQIP participating hospitals, majority of surgeons perform simple open suture repair of perforated ulcers (50.0% open suture repair only, 7.8% laparoscopic repairs, 42.2% open suture repair with omental patch) and there appears to be a plateauing of laparoscopic implementation (Figure 1). Patients undergoing simple open suture repair only had the highest mortality rate (12.25%) whereas laparoscopic repairs had the lowest mortality (7.35%). Other outcomes of including any complication, reoperation, and length of stay were similar. Of note, no historical procedures including vagotomy and drainage operations were reported during this study period.
Conclusion:
The national experience in management of perforated peptic ulcer is rare and only a small minority of surgeons perform laparoscopic patch repairs. Surprisingly, the majority of surgeons performed simple open suture repair without patch. Barriers to implementation of laparoscopic techniques warrants further study.
