Predicting Mortality and Morbidity of Patients Operated on for Perforated Peptic Ulcers

Hypothesis: Since the early 1990s, the laparoscopic technique has been increasingly used for the treatment of perforated peptic ulcer. It is important to validate a risk scoring system that can stratify patients into various risk groups before comparing the treatment outcome of laparoscopic repair against that of conventional open surgery. The scoring system should be able to predict the likelihood of mortality and morbidity. Boey score and APACHE II (Acute Physiology and Chronic Health Evaluation II) score may be of use in patient stratification.

Design: Retrospective review of relevant case notes by one reviewer.

Setting: A teaching hospital treating 0. 5 million to 1 million patients during the study period.

Patients: Patients operated on for perforated peptic ulcer between January 1989 and December 1998. Patients treated conservatively were excluded.

Main Outcome Measures: Mortality and postoperative complications (morbidity).

Results: A total of 436 patients (365 male and 71 female) with a mean +/- SD age of 51.5 +/- 18.3 years (range, 14-92 years) were studied. Duodenal perforation accounted for 344 (78.9%) of 436 cases. The mortality rate was 7.8% (34/436), and 89 patients had postoperative complications. Multivariate analysis demonstrated that only the APACHE II score predicted both mortality and morbidity. Although the Boey score predicted mortality, it failed to predict morbidity. However, the Boey score predicted the chance of conversion in patients undergoing laparoscopic repair.

Conclusions: The APACHE II score may be a useful tool for stratifying patients into various risk groups, and the Boey score might select appropriate patients for laparoscopic repair.