Ulus Travma Acil Cerrahi Derg. 2022; 28(11): 1558-1562 | DOI: 10.14744/tjtes.2022.85686

Peptik ülser perforasyonunda erken ameliyat sonrasý morbidite ve mortalite belirleyicileri

Metin Yalcin¹, Serdar Oter², Alper Akýnoðlu^3
1Antalya Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Antalya
²Manisa Þehir Hastanesi, Gastroenteroloji Cerrahisi Kliniði, Manisa
³Çukurova Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Adana

AMAÇ: Peptik ülser perforasyonu (PUP), akut karýn nedenlerinden biridir, bu durumun insidansý tüm abdominal acillerin %5’idir. PUP sonrasý morbidite ve mortalite için çok sayýda prognostik faktör bildirilmiþtir, bu çalýþma PUP’lu hastalarda mortalite ve morbiditeyi etkileyen faktörleri analiz etmeye çalýþmaktadýr.
GEREÇ VE YÖNTEM: Ocak 2008–Ocak 2018 tarihleri arasýnda kliniðimizde PUP nedeniyle opere edilen hastalarýn týbbi kayýtlarý geriye dönük olarak incelendi. Bu çalýþmaya toplam 318 hasta dahil edildi. Hastalar geriye dönük olarak yaþ, cinsiyet, komorbidite, ASA skoru, biyokimyasal, hematolojik parametreler, komplikasyonlar ve mortalite açýsýndan incelendi. Morbidite ve mortaliteyi etkileyen risk faktörleri de deðerlendirildi. BULGULAR: Çalýþma popülasyonu 318 hastadan oluþmaktaydý ve hastalarýn yaþ ortalamasý 41.30±19.37 (min-maks: 16–89) idi. Çalýþmada 271 (%85.22) hasta erkek, 47 (%14.78) kadýn ve erkek/kadýn oraný 5.76 idi. Morbidite belirteçlerinin analizinde, yaþ ≥60, (p<0.001); perforasyon-cerrahi aralýðý >24 saat (p<0.001); pürülan intraperitoneal kontaminasyon (p<0.001); ameliyat öncesi böbrek yetersizliði (p<0.001); duodenal perforasyon (p<0.001); ameliyat öncesi þok (p<0.001) ve ASA skoru >III (p<0.0001) istatistiksel olarak anlamlý bulundu. Cinsiyet istatistiksel olarak anlamlý bulunmadý (p=0.672). Ameliyat sonrasý dönemde 318 hastanýn 15’inde (%4.71) mortalite geliþti. Çok deðiþkenli analizde yaþ ≥60, (p<0.001); perforasyon-cerrahi aralýðý >24 saat (p<0.001); pürülan intraperitoneal kontaminasyon (p<0.001); ameliyat öncesi böbrek yetersizliði (p<0.001); duodenal perforasyon (p<0.001) ve ameliyat öncesi þok (p<0.001) ameliyat sonrasý mortalitenin baðýmsýz öngörücüleri olarak bulundu. TARTIÞMA: Çalýþmamýzda; yaþ ≥60, perforasyon-ameliyat aralýðý >24 saat, pürülan intraperitoneal kontaminasyon, ameliyat öncesi böbrek yetersizliði, duodenal perforasyon, ameliyat sonrasý dönemde ameliyat öncesi þok ve yoðun bakým ünitesi ameliyat sonrasý morbidite ve mortalitenin baðýmsýz öngördürücüleri olarak bulundu. Kapsamlý bir klinik deðerlendirme, yeterli sývý resüsitasyonu, uygun antibiyotik tedavisinin baþlatýlmasý ve cerrahiye erken eriþim, PUP’ta morbidite ve mortalite riskini en aza indirebilir.

Anahtar Kelimeler: Morbidite, mortalite, peptik ülser perforasyonu; prediktör faktörler.

---

Early post-operative morbidity and mortality predictors in peptic ulcer perforation

Metin Yalcin¹, Serdar Oter², Alper Akýnoðlu^3
1Department of General Surgery, Antalya Training and Research Hospital, Antalya-Türkiye
²Department of Gastroenterological Surgery, Manisa City Hospital, Manisa-Türkiye
³Department of General Surgery, Çukurova University Faculty of Medicine, Adana-Türkiye

BACKGROUND: Peptic ulcer perforation (PUP) is one of the cause of acute abdomen, incidence of this entity is 5% of all abdominal emergencies. Numerous prognostic factors have been reported for morbidity and mortality after PUP, this study attempts to analyze the factors affecting mortality and morbidity in patients with PUP.
METHODS: The medical record of patients who were operated for PUP in our clinic was retrospectively evaluated between January 2008 to January 2018. A total of 318 patients were included in this study. Patients were retrospectively analyzed in terms of age, gender, comorbidity, ASA score, biochemical, hematological parameters, complications, and mortality. The risk factors affected to morbidity and mortality were also evaluated.
RESULTS: The study population consisted of 318 patients and the mean age of the patients was 41.30±19.37 (min-max: 16–89). In the study, 271 (85.22%) patients were male and 47 (14.78%) were female and male to female ratio was 5.76. In the analysis of the predictors of morbidity, age ≥60 years, (p<0.001); perforation-surgery interval >24 h (p<0.001); purulent intraperitoneal contamination (p<0.001); pre-operative renal failure (p<0.001); duodenal perforation (p<0.001); pre-operative shock (p<0.001); and ASA score > III (p<0.0001) were found statistically significant. Gender was not found statistically significant (p=0.672). Mortality developed in 15 (4.71%) of 318 patients in the post-operative period. In the multivariate analysis, age ≥60 years, (p<0.001); perforation-surgery interval >24 h (p<0.001); purulent intraperitoneal contamination (p<0.001); pre-operative renal failure (p<0.001); duodenal perforation (p<0.001); and pre-operative shock (p<0.001) were found to be independent predictors of post-operative mortality.
CONCLUSION: In our study, age ≥60 years, perforation-surgery interval >24 h, purulent intraperitoneal contamination, pre-oper-ative renal failure, duodenal perforation, pre-operative shock, and intensive care unit in the post-operative period were found to be independent predictors of post-operative morbidity and mortality. A comprehensive clinical evaluation, adequate fluid resuscitation, initiation of appropriate antibiotic therapy, and early access to surgery can minimize the risk of morbidity and mortality in PUP.

Keywords: Morbidity, mortality, peptic ulcer perforation; predictor factors.

---

ATIF KOPYALA