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17-06-2024 | Shock

Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study

Authors: Mohamed Abouelazayem, Rajesh Jain, Michael S. J. Wilson, Alessandro Martinino, Vignesh Balasubaramaniam, Walter Biffl, Federico Coccolini, Manel Riera, Himanshu Wadhawan, Ishaan Wazir, Bettahar Abderaouf, Daniil Abramov, Mustafa A. Abu Jayyab, Khayry Al-Shami, Ahmad Alfarwan, Faris M. Alhajami, Akram Alkaseek, Ous Alozairi, Ahmed Siddique Ammar, Burak Atar, Gan-Erdene Baatarjav, Lovenish Bains, Ashraf Bakri, Nuru Bayramov, Rajesh Bhojwani, Gioia Brachini, Giacomo Calini, Michela Campanelli, Shi Yu Cheng, Charan Singh Choudhary, Sharfuddin Chowdhury, Elif Colak, Jayanta Kumar Das, Surrendar Dawani, Turgut Dönmez, Ibrahim Elzayat, Sarnai Erdene, Tashaba Qaiser Faizi, Maximos Frountzas, Besma Gafsi, Paolo Gentileschi, Mert Guler, Gaurav Gupta, Nour Elhouda Harkati, Matthew Harris, Doaa M. Hasan, Omorodion Omoruyi Irowa, Salman Jafferi, Sumita Agarwal Jain, Lai Jun Han, Satyanarayana Murthy Kandiboyina, Mehmetu Karabulut, Almu’atasim Khamees, Shahzeb Khan, Madiha Masood Khan, Cheng Jing Khaw, Michal Kisielewski, Mohamad Klib, Jurij A. Košir, Wiktor Jan Krawczyk, Giorgio Lisi, Jerry Godfrey Makama, Baila Maqbool, Cláudia Neves Marques, Serhat Meric, Mateusz Przemysław Mietła, Alaa Mohamed Ads, Joshua Muhumuza, Francesk Mulita, Matanat Mustafayeva, Mohammed A. Omar, Taryel Omarov, Akshant Anil Pathak, Ratnadeep Paul, Giovanna Pavone, Mauro Podda, Novinth Kumar Raja Ram, Fatima Rauf, Sidra Rauf, Ahmed Mohamed Safy, Erdene Sandag, Ahmet Necati Şanlı, Adeela Z. Siddiqui, Maria Sotiropoulou, Vikash Talib, Cihad Tatar, Anuroop Thota, Merve Tokocin, Aditya Tolat, Petar Angelov Uchikov, José I. Valenzuela, Sunil Kumar Venkatappa, Georgios-Ioannis Verras, Ivan Vlahović, Dafer Abdulhakim S. Zreeg, Victor Roth Cardoso, Georgios V. Gkoutos, Rishi Singhal, Kamal Mahawar, GRACE Study Collaborative Group

Published in: Surgical Endoscopy

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Abstract

Background

There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these.

Method

We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality.

Results

 1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4–2), (OR = 4.7, 95% CI 3.1–7.6)], female gender [(OR = 1.8, 95% CI 1.4–2.3), (OR = 1.9, 95% CI 1.3–2.9)], shock on admission [(OR = 2.1, 95% CI 1.7–2.7), (OR = 4.8, 95% CI 3.2–7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9–3.2), (OR = 3.9), 95% CI 2.7–5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1–1.6], but not mortality.

Conclusions

This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.

Graphical abstract

Appendix
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Metadata
Title
Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study
Authors
Mohamed Abouelazayem
Rajesh Jain
Michael S. J. Wilson
Alessandro Martinino
Vignesh Balasubaramaniam
Walter Biffl
Federico Coccolini
Manel Riera
Himanshu Wadhawan
Ishaan Wazir
Bettahar Abderaouf
Daniil Abramov
Mustafa A. Abu Jayyab
Khayry Al-Shami
Ahmad Alfarwan
Faris M. Alhajami
Akram Alkaseek
Ous Alozairi
Ahmed Siddique Ammar
Burak Atar
Gan-Erdene Baatarjav
Lovenish Bains
Ashraf Bakri
Nuru Bayramov
Rajesh Bhojwani
Gioia Brachini
Giacomo Calini
Michela Campanelli
Shi Yu Cheng
Charan Singh Choudhary
Sharfuddin Chowdhury
Elif Colak
Jayanta Kumar Das
Surrendar Dawani
Turgut Dönmez
Ibrahim Elzayat
Sarnai Erdene
Tashaba Qaiser Faizi
Maximos Frountzas
Besma Gafsi
Paolo Gentileschi
Mert Guler
Gaurav Gupta
Nour Elhouda Harkati
Matthew Harris
Doaa M. Hasan
Omorodion Omoruyi Irowa
Salman Jafferi
Sumita Agarwal Jain
Lai Jun Han
Satyanarayana Murthy Kandiboyina
Mehmetu Karabulut
Almu’atasim Khamees
Shahzeb Khan
Madiha Masood Khan
Cheng Jing Khaw
Michal Kisielewski
Mohamad Klib
Jurij A. Košir
Wiktor Jan Krawczyk
Giorgio Lisi
Jerry Godfrey Makama
Baila Maqbool
Cláudia Neves Marques
Serhat Meric
Mateusz Przemysław Mietła
Alaa Mohamed Ads
Joshua Muhumuza
Francesk Mulita
Matanat Mustafayeva
Mohammed A. Omar
Taryel Omarov
Akshant Anil Pathak
Ratnadeep Paul
Giovanna Pavone
Mauro Podda
Novinth Kumar Raja Ram
Fatima Rauf
Sidra Rauf
Ahmed Mohamed Safy
Erdene Sandag
Ahmet Necati Şanlı
Adeela Z. Siddiqui
Maria Sotiropoulou
Vikash Talib
Cihad Tatar
Anuroop Thota
Merve Tokocin
Aditya Tolat
Petar Angelov Uchikov
José I. Valenzuela
Sunil Kumar Venkatappa
Georgios-Ioannis Verras
Ivan Vlahović
Dafer Abdulhakim S. Zreeg
Victor Roth Cardoso
Georgios V. Gkoutos
Rishi Singhal
Kamal Mahawar
GRACE Study Collaborative Group
Publication date
17-06-2024
Publisher
Springer US
Keywords
Shock
Shock
Published in
Surgical Endoscopy
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-024-10881-0
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