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.
Graphical abstract
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Acknowledgements
Collaborators of GRACE Study Collaborative Group: Mohd Firdaus Bin A. Karim, Mathiban Raj A/L A. Muthu Raju, Amaar Aamery, Ashraf Abbass, Saedah Abdeewi, Ali Hussien Abdelaal, Meriem Abdoun, Naimat Ullah Abdul Rahim, Eman Ali Abdulwahed, Rashad Abizade, Mohammad Abu-Jeyyab, Jose M. Aceves-Ayala, Preeti Acharya, Débora Acín-Gándara, Ademola A. Adeyeye, Md Tanveer Adil, Peter Ikponmwosa Agbonrofo, Mabroukah Abraheem Ahjaaz, Zarka Ahmad, Omer Akay, Basim Al-Robaie, Manar Al-Shami, Nadeem B. Alabdallah, Mohammad Aldaher, Alaa Aldirani, Nassir Alhaboob, Alya Alhadi, Qamar Alhaj Ali, Altayeb Alhaj Zain, Mohammed Alharthi, Ahmad Alhashash, Ahmad Ali Ali, Abd Alwahab Alkhalaf, Nigar Allahverdiyeva, Sarah Almaqdi, Hala Almohi Alsaid Mushaweh, Mohammad Aloulou, Sarah Alsafi, Entisar Ahmed Alshareea, Mohamed Alsori, Ahmad Fais Mukriz Alwi, Mohamed Mourad Aly, Kenechukwu David Amaefuna, Farhah Asilah Binti Amer, Bashiru Aminu, Elissavet Anestiadou, Dragana Arbutina, Aziz Ari, Nikolaos Arkadopoulos, Kemal Arslan, Kriscia V. Ascencio-Díaz, Evelia Verónica Romo Ascencio, Alan Askari, Nora Ra'ed Abdullah, Atiah Rawdah Attoum, Jethro Atumanyire, Victor J. Avalos- Herrera, Selmy S. Awad, Ahmed Azam, Sarmad Saeed Aziz, Jomana Sami Azouz, Marwen Baccar, Marwa Mohamed Ali Badawi, Sharhanim Binti Bahrudin, Hibah Bileid Bakeer, Zoe Bakewell, Aditya Baksi, Mohammed Balbola, Andrea Balla, Maria Balluerca, José Adelino Laborinhas Barbosa, Laura Elisabete Ribeiro Barbosa, Francisco J. Barbosa-Camacho, Ana Lúcia Barreira, Katarzyna Bartosiak, Mohammed Basendowah, Magdy Basheer, Mutiu Adebayo Bashiru, Somprakas Basu, Zachary Baxter, José Antonio Becerra Toro, Usman Mohammed Bello, Olga Bellou, Domenico Benavoli, Alyson Bermingham, Bhavneet Singh Bhalla, Muhannud Hassan Binnawara, Alex Boddy, Joana S. Bolota, Luca Bonatti, Alessandro Michele Bonomi, Zdenko Boras, Manar M.Bouaoud Bouaoud, Souad Bouaoud, Kamel Bouchenak, Sarah Bowman, Haktan Övül Bozkır, Irma V. Brancaccio-Pérez, Marta Breda, Giacomo Carganico, Clifford Caruana, Danilo Centonze, Gabino Cervantes-Guevara, Enrique Cervantes-Pérez, Jeyadurga C. Chandramohan, Mohamed Ali Chaouch, Nicola Cillara, Brigitta Cismasiu, Christian Cotsoglou, Ben Creavin, Fabrizio D'acapito, Nour A. Dalloul, Giovanni Dapri, Dragomir Dardanov, Bhuban Mohan Das, Maurizio De Luca, Luca Degrate, Jonathan Abraham Demma, Khawla Derwish, Costanza Distefano, Agron Dogjani, Zhiyong Dong, Claire Donohoe, Panagiotis Dorovinis, Anne Sophie Dulac, Helen Earley, Sanketh Edem, Michael El Boghdady, Mohamed A. El Sayed, Ahmed H El Shamarka, Tarek I. El-Houssari, Peter Oluwatobi Elemile, Khamis Elessi, Hosam M. Elghadban, Laila Kamel Elgherwi, Ahmed E. Elghrieb, Mayar El-Haddad, Muhammed Elhadi, Ahmed Mohammed Elshaer, Ikenna Cletus Emejulu, Ghada Enani, Giorgio Ercolani, Ergin Erginöz, Suraj Ethiraj, Giuseppe Evola, Syaza Najwa Binti Faizul, Daniel Moritz Felsenreich, Melissa A. Fernandez Zurita, Federico Festa, Alessia Fiore, Yuri Fishman, Muratcan Fırat, Mimia Fouadla, Massimo Framarini, Francesco Frattini, Clotilde Fuentes-Orozco, Farah Gahramanova, Laurent Genser, Farid Gerges, Ioannis N. Gerogiannis, Ahmed Abdualla S. Gerwash, Munir Ghandour, Ahmad Ghazal, Mohamad Ghazal, Ali Abdullah Gill, Hana Yousef Gineeb, Rossella Gioco, Nakul Gokhare Viswanath, Ricardo A. T. Gonsaga, Alejandro González- Ojeda, Fanny Y.González-Ponce, Aakansha Giri Goswami, Yitka Graham, Stefano Granieri, Jan Grosek, Rahul Gupta, Amit Gupta, Deniz Güzey, Bertha G. Guzmán-Ramírez, Mario J. Guzmán- Ruvalcaba, Sana Hamayun, Hytham K. S. Hamid, Abdul Rahman Hammadieh, Abdallatef Hasan, Abdul Haseeb, Siti Rahmah Hashim Isa Merican, İsmail Hasırcı, Eric J. Hazebroek, Susana Henriques, Farhanul Huda, Silvia A. Ibarra-Camargo, Ufuk Oguz Idiz, Kelly Iles, Orestis Ioannidis, Solomon N. Irmiya, Vikas Jain, Azalea Jan, Christopher Jones, Nicholas Jimbun Anak Juli, Abram Calinton Bin Justin, Stylianos Kapiris, Panagiotis Kapsampelis, Supreet Kaur, Alfie J. Kavalakat, Ahmad Amir H. Kayali, Myrto D. Keramida, Amir Hamza Khan, Archana Khanduri, Rama Khatib, Shehrbano Khattak, Choon Keat Kim, Guowei Kim, Panagiotis Kokoropoulos, Katarzyna Komorowska, Jurij A. Košir, Angeliki Kosti, Aya Tinhinane Kouicem, Aya Tinhinane A.Kouicem, Bojan Kovacevic, Shyam Karuppusamy Krishnasamy, Rabia Kucukarslan Guler, Navin Kumar, Mikhail Kurtenkov, Stylianos Kykalos, Hampher Kynjing, Pierfrancesco Lapolla, Mohammed Hakim Larbi, Omar Lasheen, Wan Teng Lee, Pasquale Lepiane, Alessio Licciardello, Rita Rmp Lima, Enrico Lodo, Zbigniew Lorenc, Waleed Mabood, Nikolaos Machairas, Brij Madhok, Mohamed Shafi Mahboob Ali, Ahmed S. Mahdi, Hasan Mahmoud, Nadim Malibary, Dhiraj Mallik, Shabnam Mammadova, Luka Mandic, Roberto Mares-País, Gad Marom, Cláudia Neves Marques, Ruqaya J. Masri, Pietro Masseria, Annabel M. Mclean, Mohd Nizam Md Hashim, Mohd Adlan Bin Md Kamal, Manuel Medina-García, Aissam Megaache, Mel P. Mellado-Tellez, Adriel C. Meneghello, Nikolaos V. Michalopoulos, Andrea Mingoli, Mohamed Salah Mohalal, Ikhwan Sani Mohamad, Salma Tarek Mohamed, Maimuna Zahra Binti Mohamed Fadzil, Almarri Mohammad, Mauro Montuori, Damián Mora-Santana, Dimitrios Moris, Arinzechukwu O. Mosanya, Vasileios Mousafeiris, Alaa Mousli, Odysseas Mouzakis, Aiman Nuri Muftah, Francesk Mulita, Theodore F. Nabavi, Areej Esam Aish Nadeesh, Rodrigo Nájar-Hinojosa, Mahfoud Najjar, Mohannad Nasani, Constantinos Nastos, Peter M. Neary, Ahmed R. Negm, Itzel Ochoa-Rodríguez, Stefano Olmi, Steve-Nation Nehiweze Oriakhi, Ana P. Orozco-Gallardo, Monday Omoruyi Osarenkhoe, Amel A. Ouyahia, Mehmet Faik Özçelik, Zeynep Özdemir, Ferman Tevfik Özyalvaç, Dimitrios Papaconstantinou, Francesco Saverio Papadia, Maria Papadoliopoulou, Aristeidis Papadopoulos, Christos Papazacharias, Chetan Parmar, Patricia Paunero, G. Pawan, Rocío Pérez Quintero, Enrico Pinotti, Adolfo Pisanu, Sunil Popat, Dimitri Pournaras, Sjaak Pouwels, Omar Qassab, Francesco Quaglino, Anbarasan Rasadurai R. Anbarasan, Mubashir Rafique, Atiqur Rahman, Mounira M. Rais, Malairman R. Rajayokiam, Deepak Rajput, Rosnelifaizur Ramely, Luis R. Ramirez-Gónzalez, Gopi Ramu, Nawwar Reslan, Giordana Riccioli, Vakulabharanam Naga Rohith, Kimutai S. Ronoh, Homayoon Roshan, Cornelio Ruelas-Bravo, Elena Ruiz-Úcar, Alifa Sabir, Nait Ali Sabrin, Ahmed Abdelfattah Sabry, Mehmet Emin Şahin, Amira Said, Nasser Sakran, Yara M. Salem, Syahrul Anuar Salleh, Virginia Sangpliang, Dina Hesham Sapry, Francesca Maria Chiara Savasta, Khaled Ahmad Sawaftah, Juan Pablo Scarano Pereira, Dimitrios Schizas, Husnu Sevik, Asim Shabbir, Ahmad Shahroz, Haitam Shames, Ankur Sharma, Sahil Shet, Mohamed S. Shetiwy, Ashraf Shoma, Fakhar Munir Sial, Theodoros A. Sidiropoulos, Sudhir Kumar Singh, Jimmy Bok Yan So, Jien Yen Soh, Leonardo Solaini, Stefania Soncini, Enas Soula, Fabiana Filipa Silva Sousa, Ludovica Stella, Luis O. Suárez-Carreón, Dhivakar Sugumar, Mohamed Swamad, Athanasios Syllaios, Savvas Symeonidis, Benali Tabeti, Ekaterini Christina Tampaki, Nicola Tartaglia, Yen Zhir Tay, Tengku Nazim Bin Tengku Yusof, Nilanjana Tewari, Anisse Tidjane, Beatrice Torre, Matteo Uccelli, Fara M.L. Uccelli, Server Sezgin Uludağ, Mehmet Eşref Ulutaş, Bashir Musa Umar, Hyeladi Malgwi Usman, Anthony Uwuigbe, Michail Vailas, Susan Sofia Gonçalves Vaz, Jesús O. Vega-Gastelum, Massimiliano Veroux, Yirupaiahgari K. S. Viswanath, Ivan Vlahović, Maciej Walędziak, Wan Mokhzani Wan Mokhter, Wan Zainira Wan Zain, Huaxi Wang, Hisham H. Warda, Zhuoqi Wei, Michael Pak-Kai Wong, Geoffrey Yuet Mun Wong, Maya Mazuwin Yahya, Wah Yang, Michael S. Yule, Zaidi Zakaria, Andee Dzukarnaen Zakaria, Maria F. Zarate-Casas, Kağan Zengin, Junchang Zhang.
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Mohamed Abouelazayem, Rajesh Jain, Michael SJ Wilson, Alessandro Martinino, Vignesh Balasubaramaniam, Walter Biffl, Federico Coccolini, Manel Riera, Himanshu Wadhawan, Ishaan Wazir, Bettahar Abderaouf, Daniil Abramov, Mustafa A. Abu Jayyab, Khayry Al-Shami, Ahmad Alfarwan, Faris M. Alhajami, Akram Alkaseek, Ous Alozairi, Ahmed Siddique Ammar, Burak Atar, Gan-Erdene Baatarjav, Lovenish Bains, Ashraf Bakri, Nuru Bayramov, Rajesh Bhojwani, Gioia Brachini, Giacomo Calini, Michela Campanelli, Shi Yu Cheng, Charan Singh Choudhary, Sharfuddin Chowdhury, Elif Colak, Jayanta Kumar Das, Surrendar Dawani, Turgut Dönmez, Ibrahim Elzayat, Sarnai Erdene, Tashaba Qaiser Faizi, Maximos Frountzas, Besma Gafsi, Paolo Gentileschi, Mert Guler, Gaurav Gupta, Nour Elhouda Harkati, Matthew Harris, Doaa M. Hasan, Omorodion Omoruyi Irowa, Salman Jafferi, Sumita Agarwal Jain, Lai Jun Han, Satyanarayana Murthy Kandiboyina, Mehmetu Karabulut, Almu’atasim Khamees, Shahzeb Khan, Madiha Masood Khan, Cheng Jing Khaw, Michal Kisielewski, Mohamad Klib, Jurij A. Košir, Wiktor Jan Krawczyk, Giorgio Lisi, Jerry Godfrey Makama, Baila Maqbool, Cláudia Neves Marques Serhat Meric, Mateusz Przemysław Mietła, Alaa Mohamed Ads, Joshua Muhumuza, Francesk Mulita, Matanat Mustafayeva, Mohammed A. Omar, Taryel Omarov, Akshant Anil Pathak, Ratnadeep Paul, Giovanna Pavone, Mauro Podda, Novinth Kumar Raja Ram, Fatima Rauf, Sidra Rauf, Ahmed Mohamed Safy, Erdene Sandag, Ahmet Necati Şanlı, Adeela Z. Siddiqui, Maria Sotiropoulou, Vikash Talib, Cihad Tatar, Anuroop Thota, Merve Tokocin, Aditya Tolat, Petar Angelov Uchikov, José I. Valenzuela, Sunil Kumar Venkatappa, Georgios-Ioannis Verras, Ivan Vlahović, Dafer Abdulhakim S. Zreeg, Victor Roth Cardoso, Georgios V. Gkoutos, Rishi Singhal, Kamal Mahawar, GRACE Study Collaborative Group have no conflicts of interest or financial ties to disclose.
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Abouelazayem, M., Jain, R., Wilson, M.S.J. et al. Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study. Surg Endosc 38, 4402–4414 (2024). https://doi.org/10.1007/s00464-024-10881-0
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DOI: https://doi.org/10.1007/s00464-024-10881-0