PPU: Prompt Surgery Critical for Survival
PPU: Prompt Surgery Critical for Survival
Buck DL, Vester-Andersen M, Moller MH
Br J Surg. 2013;100:1045-1049
How important is prompt surgery for the management of perforated peptic ulcer? The authors used data from 2668 patients with this diagnosis who were surgically treated in Denmark from 2003 to 2009. They studied the relationship between time from admission to surgery and 30-day survival. The overall 30-day mortality rate was 26.5%. The median time interval from admission to surgery was 5 hours. In a multivariate model, each hour of delay was associated with a 2.5% decrease in survival.
With the advent of modern therapy for treating peptic ulcer disease, the frequency of perforated ulcer disease has diminished greatly. Surgery is still the recommended therapy for perforated ulcer disease despite occasional reports of successful nonoperative management. These data from an entire country with high surgical standards reveal that the mortality from perforated peptic ulcer is still high. As the authors pointed out, the only disease requiring emergency surgery with a higher mortality rate is ruptured aortic abdominal aneurysm. We do not know the reasons for delayed surgery, but the time required to obtain a CT scan could be a factor. Because the report does not provide information about the timing of administered antibiotics, it is possible that some of the adverse effects of surgical delay could be related to delayed antibiotic administration.
Abstract
Surgical Delay Is a Critical Determinant of Survival in Perforated Peptic Ulcer
Buck DL, Vester-Andersen M, Moller MH
Br J Surg. 2013;100:1045-1049
Summary
How important is prompt surgery for the management of perforated peptic ulcer? The authors used data from 2668 patients with this diagnosis who were surgically treated in Denmark from 2003 to 2009. They studied the relationship between time from admission to surgery and 30-day survival. The overall 30-day mortality rate was 26.5%. The median time interval from admission to surgery was 5 hours. In a multivariate model, each hour of delay was associated with a 2.5% decrease in survival.
Viewpoint
With the advent of modern therapy for treating peptic ulcer disease, the frequency of perforated ulcer disease has diminished greatly. Surgery is still the recommended therapy for perforated ulcer disease despite occasional reports of successful nonoperative management. These data from an entire country with high surgical standards reveal that the mortality from perforated peptic ulcer is still high. As the authors pointed out, the only disease requiring emergency surgery with a higher mortality rate is ruptured aortic abdominal aneurysm. We do not know the reasons for delayed surgery, but the time required to obtain a CT scan could be a factor. Because the report does not provide information about the timing of administered antibiotics, it is possible that some of the adverse effects of surgical delay could be related to delayed antibiotic administration.
Abstract
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