Noguiera et al evaluated patients requiring surgery for a perforated peptic ulcer. They identified risk factors associated with morbidity and mortality which can help determine those patients who may require more aggressive management. The authors are from the Instituto de Ciencias Biomedicas Abel Salazar in Oporto, Portugal.


Exclusion: perforation associated with malignancy


Types of operative management:

(1) drainage operation (pyloroplasty or gastrojejunostomy) and troncular vagotomy

(2) simple suturing of the ulcer

(3) resection (subtotal gastrectomy or antrectomy with vagotomy)


Postoperative morbidity included organ failure, infection and wound complications.


Mortality involved death within 4 weeks after surgery.


Risk factors for morbidity and mortality:

(1) age >= 50 years of age

(2) hypotension on admission (systolic blood pressure < 100 mm Hg)

(3) presence of significant comorbid disease(s), including cirrhosis, cardiovascular disease, respiratory disease, renal disease, diabetes mellitus, rheumatoid arthritis and multi-joint arthritis (? drug-induced ulceration)

(4) evolution of perforation > 24 hours prior to surgery

(5) operation involved resection


Additional risk factors for mortality:

(1) male gender

(2) operation with simple suturing of ulceration



• The odds ratios for morbidity ranged from 1.6 for hypotension to 22 for resection.

• The odds ratios for mortality ranged from 2.3 for simple suturing to 18 for significant comorbid disease.

• The implementation used presence or absence of risk factors irrespective of the odds ratio. An alternative approach is to weight points for the odds ratio.


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