A study of factors associated with mortality in patients managed for perforated peptic ulcers at University Teaching Hospital, Lusaka, Zambia

Abstract

Perforated Peptic ulcers (PPU) is one of the common finding in patients undergoing emergency laparotomy for peritonitis at UTH, Adult Hospital, department of surgery, representing about 26.45% of these cases in a calendar year. A high risk of mortality and morbidity is encountered in patients treated with surgery for PPU. Patient stratification and appropriate management according to patients risk of mortality, has been recommended as a way of trying to improve outcomes in patients with PPU. The aim of the study was to investigate the factors associated with mortality in patients that present with PPU managed surgically at UTH. This was a prospective cohort study, conducted at UTH-Adult Hospital, Department of surgery targeting patients with PPU that had undergone emergency laparotomy. They were enrolled using interview administered questionnaire and followed up for 30-days post-operation. The primary outcome was 30 day postoperation mortality. The study enrolled 38 participants of which 35 participants met the inclusion criteria, 88.57% (n=31) male and 11.43% (n=4) female. The age ranged from 14 years to 84 years with the mode age ranges 20 years – 30 years and 40 years – 50 years. Most patients presented with two (2) or more complaints. Abdominal pain was common presenting complaint in all the patients and other complaints included, nausea and vomiting, abdominal distension and constipation. 82.86% (n=29) of the participants presented after 24 hours of onset of symptoms, 17.14% (n=6) were HIV positive and 42.86% (n=15) were in shock on presentation. More than half of the participants were assessed as ASA score III or greater. On admission 40.00 % (n=14) had elevated serum creatinine and 37.1 % (n=13) had low serum albumin. 91.43% (n=32) of PPU were gastric perforations and 8.57 % (n=3) duodenal perforations and the mode and median range of size of perforation was 5mm – 10mm. Length of hospital stay ranged from one(1) day to 13 days with a mean of 7.29 days. 30-day post-operation mortality was 34.29% and 40% of the participants developed a post operation complication. Univariate binary regression analysis found Age, ASA score, Serum creatinine, and Size of perforation to be significantly associated with mortality (p-value <0.05, C.I. 95%). Univariate linear regression analysis found HIV positive Status, and CD4 cell count level to be significantly associated with mortality(p-value <0.05; 95% C.I.). Multivariate binary regression analysis found no significant association with mortality of the above variables (p-value <0.05; C.I. 95%). PPU is a common finding among patients with peritonitis undergoing emergency surgery at UTH and is associated with high mortality. Univariate statistical analysis found Age, ASA score, Serum creatinine, Size of peptic ulcer perforation, HIV Status and CD4 cell count level to be associated with mortality. However, no factor was found to be significantly associated with mortality on multivariate regression analysis. KEY WORDS: PPU, 30-Day post-operation Mortality, Laparotomy