Jun Su, Dr1, Yiong Hauk Chan, Dr2, Vishalkumar G Shelat, Asst Professor1. 1Tan Tock Seng Hospital, 2National University of Singapore
Introduction: Surgery for perforated peptic ulcer (PPU) is associated with high mortality in elderly patients. Existing PPU mortality risk prediction models (MRPM) lack simplicity and objectivity. We validate two widely used MRPMs. We hypothesize that more accurate mortality can be predicted in elderly PPU patients by simple preoperative variables.
Methods: Patients with age >70 years and operated for PPU from January 2004 to December 2012 were recruited. Preoperative, operative and postoperative data were collected. Boey’s score and Mannheim peritonitis index (MPI) are commonly used and validated. Mortality predictors were obtained using odds ratios of the significant multivariate variables on mortality as weightage.
Results: 170 patients were eligible. 95 (55.9%) patients were male and 111 patients (65.3%) presented >24 hours after abdominal pain onset. 68 (40%) patients had co-morbidities and 95 (55.9%) showed free air on erect chest X-ray. Median length of stay was 12 days (1-128). Intra-abdominal collection, leakage, reoperation and mortality were 15.9%, 5.3%, 1.8% and 19.4% respectively. Boey’s score and MPI had areas under curve (AUC) of 64.4% and 63.0% respectively for mortality prediction. On univariate analysis, preoperative shock, cardiac failure, chronic renal failure, American society of Anesthesiology (ASA) score, urea and serum createnine were predictive of mortality. Urea >15 mg/dL (p= 0.015, OR- 4.73 (95% CI 1.35-16.58)) and ASA score > 2 (p=0.03, OR – 10.6 (95% CI 1.3-88.4)) were identified as mortality predictors in the elderly PPU population.
Conclusion: Boey’s score and MPI lack accuracy to predict mortality in elderly PPU patients. ASA status and elevated urea predict mortality. It remains to be explored if adding urea and ASA status enhances existing MRPMs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87577
Program Number: P064
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster