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

Abouelazayem M 1 , Jain R 2 , Wilson MSJ 3 , Martinino A 4 , Balasubaramaniam V 5 , Biffl W 6 Show all authors , Coccolini F 7 , Riera M 8 , Wadhawan H 3 , Wazir I 9 , Abderaouf B 10 , Abramov D 11 , Abu Jayyab MA 12 , Al-Shami K 13 , Alfarwan A 14 , Alhajami FM 15 , Alkaseek A 16 , Alozairi O 17 , Ammar AS 18 , Atar B 19 , Baatarjav GE 20 , Bains L 21 , Bakri A 22 , Bayramov N 23 , Bhojwani R 24 , Brachini G 25 , Calini G 26 , Campanelli M 27 , Cheng SY 28 , Choudhary CS 29 , Chowdhury S 30 , Colak E 31 , Das JK 32 , Dawani S 33 , Dönmez T 34 , Elzayat I 35 , Erdene S 36 , Faizi TQ 33 , Frountzas M 37 , Gafsi B 38 , Gentileschi P 27 , Guler M 39 , Gupta G 29 , Harkati NE 40 , Harris M 41 , Hasan DM 42 , Irowa OO 43 , Jafferi S 33 , Jain SA 29 , Jun Han L 44 , Kandiboyina SM 45 , Karabulut M 19 , Khamees A 13 , Khan S 46 , Khan MM 33 , Khaw CJ 28 , Kisielewski M 47 , Klib M 14 , Košir JA 48 , Krawczyk WJ 49 , Lisi G 50 , Makama JG 51 , Maqbool B 52 , Marques CN 53 , Meric S 54 , Mietła MP 49 , Ads AM 55 , Muhumuza J 56 , Mulita F 57 , Mustafayeva M 58 , Omar MA 59 , Omarov T 23 , Pathak AA 60 , Paul R 61 , Pavone G 62 , Podda M 63 , Raja Ram NK 64 , Rauf F 65 , Rauf S 66 , Safy AM 59 , Sandag E 36 , Şanlı AN 67 , Siddiqui AZ 33 , Sotiropoulou M 68 , Talib V 33 , Tatar C 39 , Thota A 45 , Tokocin M 54 , Tolat A 9 , Uchikov PA 69 , Valenzuela JI 70 , Venkatappa SK 71 , Verras GI 57 , Vlahović I 72 , Zreeg DAS 73 , Cardoso VR 74 , Gkoutos GV 74 , Singhal R 75 , Mahawar K 76 , GRACE Study Collaborative Group

Affiliations 

  • 1 Department of Surgery, University College London Hospitals, London, UK. m.abouelazayem@nhs.net
  • 2 Shrewsbury & Telford Hospital NHS Trust, Shrewsbury, UK
  • 3 Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
  • 4 Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
  • 5 Ysbyty Gwynedd Hospital, Bangor, Wales, UK
  • 6 Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, San Diego, CA, USA
  • 7 General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
  • 8 Royal Shrewsbury Hospital, Shrewsbury, UK
  • 9 VMMC & Safdarjung Hospital, New Delhi, India
  • 10 Public Hospital Establishment Mohamed Sayah of SOBHA, Algeria, Algeria
  • 11 Immanuel Kant Baltic Federal University, Kaliningrad, Russia
  • 12 Nasser Medical Complex, Gaza, Palestine
  • 13 Al-Basheer Hospital, Amman, Jordan
  • 14 Damascus University, Damascus, Syria
  • 15 United Hospital, 21 September University, Yemen, Yemen
  • 16 Gharyan Central Hospital, Garian, Libya
  • 17 Aladan Hospital, Hadiya, Kuwait
  • 18 MAYO Hospital, Lahore, Pakistan
  • 19 Bakırköy Training and Research Hostpital, Bakirkoy, Turkey
  • 20 The Second State Central Hospital, Ulaanbaatar, Mongolia
  • 21 Maulana Azad Medical College, New Delhi, India
  • 22 Tishreen University Hospital, Latakia, Syria
  • 23 Azerbaijan Medical University, Baku, Azerbaijan
  • 24 Santokba Durlabhji Memorial Hospital (SDMH), Jaipur, India
  • 25 Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
  • 26 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
  • 27 San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
  • 28 Penang General Hospital, George Town, Malaysia
  • 29 SMS Hospital, Jaipur, India
  • 30 King Saud Medical City, Riyadh, Saudi Arabia
  • 31 University of Samsun, Samsun, Turkey
  • 32 Nazareth Hospital, Shillong, India
  • 33 Jinnah Postgraduate and Medical Center, Karachi, Pakistan
  • 34 Bakırköy Training and Research Hospital, Bakirkoy, Turkey
  • 35 Faculty of Medicine, Aswan University, Aswan, Egypt
  • 36 Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
  • 37 First Propaedeutic Department of Surgery, Hippocration General Hospital of Athens, Athens, Greece
  • 38 Fattouma Bourguiba University Hospital, Monastir, Tunisia
  • 39 Istanbul Research and Training Hospital, Istanbul, Turkey
  • 40 University Hospital Center-Benflis Touhami-Batna, Batna, Algeria
  • 41 Royal Liverpool and Broadgreen NHS Trust, Liverpool, UK
  • 42 Imbaba General Hospital, Giza, Egypt
  • 43 University of Benin Teaching Hospital, Benin City, Nigeria
  • 44 Hospital Melaka, Melaka, Malaysia
  • 45 NRI Medical College, General & Superspeciality Hospital, Chinakakani, India
  • 46 MTI Khyber Teaching Hospital, Peshawar, Pakistan
  • 47 Akademia Frycza-Modrzewskiego, Kraków, Poland
  • 48 UMC Ljubljana, Ljubljana, Slovenia
  • 49 Clinical Department of General, Colorectal and Trauma Surgery, Medical University of Silesia, Katowice, Poland
  • 50 Department of Surgery, Sant'Eugenio Hospital, Viale Dell'Umanesimo 10, Rome, Italy
  • 51 Department of Surgery, Barau Dikko Teaching Hospital-KASU, Kaduna, Nigeria
  • 52 University of New Mexico, Albuquerque, USA
  • 53 Centro Hospitalar Universitario, Lisbon Central, Lisbon, Portugal
  • 54 Bagcilar Training and Research Hospital, Istanbul, Turkey
  • 55 Tanta University Hospital, Tanta, Egypt
  • 56 Kampala International University, Kampala, Uganda
  • 57 General University Hospital of Patras, Rio, Greece
  • 58 Scientific Center of Surgery After Named M.A.Topchubashov, Azerbaijan, Azerbaijan
  • 59 General Surgery Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
  • 60 GTB Hospital, New Delhi, Delhi, India
  • 61 Silchar Medical College, Silchar, India
  • 62 University of Foggia, Foggia, Italy
  • 63 Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
  • 64 Department of Surgery, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
  • 65 Benazir Bhutto Hospital, Rawalpindi, Pakistan
  • 66 Pakistan Institute of Medical Sciences, Islamabad, Pakistan
  • 67 Abdulkadir Yüksel State Hospital, Gaziantep, Turkey
  • 68 Evagelismos Hospital, Athens, Greece
  • 69 Univesity Hospital St. George, Plovdiv, Bulgaria
  • 70 Hospital Velez Sarsfield, Ciudadela, Argentina
  • 71 Victoria Hospital, Bangalore Medical College & Research Institute, Bengaluru, India
  • 72 Department of Surgery, Clinical Hospital Center Osijek, University of Osijek, Osijek, Croatia
  • 73 Alkhadra Hospital, Tripoli, Libya
  • 74 Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
  • 75 University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
  • 76 South Tyneside and Sunderland NHS Foundation Trust, University of Sunderland, Sunderland, UK
Surg Endosc, 2024 Aug;38(8):4402-4414.
PMID: 38886232 DOI: 10.1007/s00464-024-10881-0

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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