M. Stawikowska1, 3, G. Toryn2, C. Marques2, M. Pansari1, M. Jacobs1, 3, S. Patil1, 3 3Michigan State University, College Of Human Medicine, Lansing, MI, USA 1Ascension Providence Hospital, General Surgery, Southfield, MI, USA 2American University of the Carribean, Medical School, Southfield, MI, USA
Introduction:
Perforated peptic ulcer is an acute surgical emergency and surgical intervention is the standard of care. However, in certain patients the risk of surgery outweighs its benefit, and they are simply better suited for conservative management. This current study compares the outcomes of surgical and conservative management of patients with a perforated peptic
ulcer.
Methods:
National Inpatient Database (NIIS 1998-2014) was used to identify patients admitted with a perforated peptic ulcer (ICD 531.10, 532.10). Standard statistical methods were used to evaluate demographic data and outcomes of patients who were treated conservatively or with surgery.
Results:
10,033 patients were admitted with an acute perforated peptic ulcer, with a M to F ratio 0.97:1. Mean age was 62.3±2 years. 58.8% of patients were Caucasian, 10.2% African American, 5.0% Hispanic and 2.7% Asian Pacific Islanders. 1,209 (12%) patients received no surgery, while 8,824 (88%) underwent surgery. Average age was 62.1±19.0 in surgery and 63.9 ±18.9 in no-surgery group. Surgery was the prevalent treatment across all races with no significant difference in treatment and discharge to home status. Nearly 55% patients in both groups were discharged to home. Mortality rate was 11.4% in surgery compared to 14.3% in no- surgery group, p <0.01. Surgical patients developed complications more commonly than no- surgery group, especially cardiac (4.1% vs. 1.0%) and respiratory complications (11.2% vs. 5.5%) were statistically significant, p <0.01. 83.9% of patients in rural hospitals underwent surgery, compared to 89.8% at urban non-teaching and 87.8% at urban teaching hospitals, p<0.01. The hospitalization cost and LOS was significantly higher in the surgical group, p<0.01.
Conclusion:
Surgery is the prevalent form treatment for perforated peptic ulcer, across allraces. Surgical intervention is less common in rural hospitals. Surgical intervention is associated with higher cardiac and respiratory complications, increased cost of care and LOS.
However, mortality rates were significantly higher in no-surgery group (14.3% vs. 11.40%). Further single institution studies are needed to validate these findings and provide treatment guidelines.
