Major risk factors for mortality based on multivariate analysis:
(1) ASA score (very high for ASA V, high for ASA IV, low to moderate for ASA III)
(2) age > 65 years
(3) delay in surgery > 24 hours
(4) shock
(5) definitive surgery (rather than simple closure of the perforation; definitive procedures were (a) vagotomy with antrectomy or pyloroplasty or (b) subtotal gastrectomy with gastroenterostomy)
Other factors affecting outcome:
(1) presence of comorbid conditions
(2) winter season (associated with delay in surgery and increased morbidity)
(3) perforation size >= 0.5 cm in diameter
(4) female gender
(5) nonsmoker
(6) ulcer type III (pyloric channel ulcer) or IV (proximal stomach or gastric cardia)
Factors associated with > 66% mortality rate and p value < 0.05:
(1) ASA score V
(2) shock
Factors associated with a 33-66% % mortality rate and p value < 0.05:
(1) ASA score IV
(2) definitive surgical procedure
(3) perforation size > 1 cm in diameter
(4) age > 65 years
Factors associated with a 7-32% mortality rate and p value < 0.05:
(1) female
(2) nonsmoker
(3) comorbid condition
(4) ASA III
(5) Type III or IV ulcer
(6) simple closure (not definitive surgery)
(7) perforation size 0.5 to 1.0 cm
