An evaluation of the epidemiology, management and outcomes for perforated peptic ulcers across the North of England over 15 years: A retrospective cohort study.
Emergency Surgery
Laparoscopy
Laparotomy
Peptic Ulcer
Perforation
Upper Gastrointestinal Surgery
Journal
International journal of surgery (London, England)
ISSN: 1743-9159
Titre abrégé: Int J Surg
Pays: United States
ID NLM: 101228232
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
18
11
2018
revised:
08
02
2019
accepted:
05
03
2019
pubmed:
16
3
2019
medline:
16
5
2019
entrez:
16
3
2019
Statut:
ppublish
Résumé
The management of perforated peptic ulcers has evolved over time and includes laparoscopic or open repair, and conservative management. The utilisation of, and outcomes from these strategies are not clear. Trends in epidemiology, management and outcomes for perforated peptic ulcer across the North of England over a 15-year period were analyzed. Emergency General Surgical admissions data from nine NHS trusts in the North of England from 2002 to 2016 were collected and analyzed, including demographics, interventions and outcomes. Cases were identified using ICD-10 codes K25, K26 and K27 0.1, 0.2, 0.5, 0.6. Peptic ulcer perforation accounted for 2373 of 491141 admissions (0.48%), with a decreased incidence over time (0.62% in 2002-2006 to 0.36% in 2012-2016). Over the 15 years studied, an increasing proportion of cases were managed laparoscopically (4.5%-18.4%, p < 0.001) and under upper-gastrointestinal consultants (15.4%-28.6%, p < 0.001). Thirty-day inpatient mortality improved significantly over time (20.0%-10.8%, p < 0.001) as did mean length of stay (17.3-13.0 days, p = 0.001). Independent predictors of increased 30-day mortality were increasing age, Charlson co-morbidity score, clinical and operative risk, earlier year of admission, winter admission, weekend/bank holiday procedure and management strategy, with laparotomy and conservative management increasing risk. Outcomes (30-day mortality and LOS) improved significantly over the study period. Laparoscopic approach was increasingly utilised and was an independently significant factor associated with improved mortality. Management by upper-gastrointestinal specialists increased rates of laparoscopy, with fewer conversions to open.
Sections du résumé
BACKGROUND
BACKGROUND
The management of perforated peptic ulcers has evolved over time and includes laparoscopic or open repair, and conservative management. The utilisation of, and outcomes from these strategies are not clear. Trends in epidemiology, management and outcomes for perforated peptic ulcer across the North of England over a 15-year period were analyzed.
PATIENTS AND METHODS
METHODS
Emergency General Surgical admissions data from nine NHS trusts in the North of England from 2002 to 2016 were collected and analyzed, including demographics, interventions and outcomes. Cases were identified using ICD-10 codes K25, K26 and K27 0.1, 0.2, 0.5, 0.6.
RESULTS
RESULTS
Peptic ulcer perforation accounted for 2373 of 491141 admissions (0.48%), with a decreased incidence over time (0.62% in 2002-2006 to 0.36% in 2012-2016). Over the 15 years studied, an increasing proportion of cases were managed laparoscopically (4.5%-18.4%, p < 0.001) and under upper-gastrointestinal consultants (15.4%-28.6%, p < 0.001). Thirty-day inpatient mortality improved significantly over time (20.0%-10.8%, p < 0.001) as did mean length of stay (17.3-13.0 days, p = 0.001). Independent predictors of increased 30-day mortality were increasing age, Charlson co-morbidity score, clinical and operative risk, earlier year of admission, winter admission, weekend/bank holiday procedure and management strategy, with laparotomy and conservative management increasing risk.
CONCLUSION
CONCLUSIONS
Outcomes (30-day mortality and LOS) improved significantly over the study period. Laparoscopic approach was increasingly utilised and was an independently significant factor associated with improved mortality. Management by upper-gastrointestinal specialists increased rates of laparoscopy, with fewer conversions to open.
Identifiants
pubmed: 30872174
pii: S1743-9191(19)30061-5
doi: 10.1016/j.ijsu.2019.03.005
pii:
doi:
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
24-32Informations de copyright
Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.