Kocer et al evaluated risk factors for morbidity and mortality in patients with a perforated peptic ulcer. These can help identify patients who may benefit from more aggressive or modified therapeutic approaches. The authors are from Ankara Numune Training and Research Hospital in Ankara, Turkey.


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


(5) Type III or IV ulcer

(6) simple closure (not definitive surgery)

(7) perforation size 0.5 to 1.0 cm


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