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    Predictors of mortality in the elderly after open repair for perforated peptic ulcer disease

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    Authors
    Daniel, Vijaya
    Wiseman, Jason T.
    Flahive, Julie
    Santry, Heena
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2017-07-01
    Keywords
    Elderly
    Outcomes
    Peptic ulcer disease
    Surgical repair
    UMCCTS funding
    Clinical Epidemiology
    Digestive System Diseases
    Epidemiology
    Geriatrics
    Pathological Conditions, Signs and Symptoms
    Surgery
    Surgical Procedures, Operative
    Translational Medical Research
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    Link to Full Text
    https://doi.org/10.1016/j.jss.2017.03.052
    Abstract
    BACKGROUND: As the U.S. population ages and the number of emergent surgical repairs for perforated peptic ulcer disease (PUD) rise, contemporary national data evaluating operative outcomes for open surgical repair for perforated PUD among the elderly are lacking. MATERIALS AND METHODS: The National Surgical Quality Improvement Program (2007-2014) was queried for patients > /=65 y who underwent open surgical repair for perforated PUD. The primary outcome was 30-d mortality. Secondary outcomes included 30-d postoperative complications. Univariate and multivariable regression analyses were performed. RESULTS: Overall, 2131 patients underwent open surgical repair for perforated PUD. Among those who died, more used steroids preoperatively (15% versus 9%, P = 0.001) and fewer were independent preoperatively (55% versus 83%, P < 0.0001) compared to those who were alive 30-d postoperatively. Common postoperative complications were septic shock (15%) and pneumonia (12%). The overall 30-d mortality rate was 17.7%, with more deaths in subsequent decades of life (65-75 y 13% versus 75-84 y 18% versus > 85 y 24%, P < 0.0001). After adjustment for other factors, mortality was significantly associated with older age (85+ versus 65-74 y) (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.8, 1.7), dependent functional status preoperatively ([OR], 0.2; 95% CI, 0.2, 0.3), and American Society of Anesthesiologist classification > /=4 (OR, 3.2; 95% CI, 2.4, 4.3). CONCLUSIONS: At U.S. hospitals, open surgical repair, the accepted treatment of perforated PUD, among the elderly is associated with significant 30-d morbidity and mortality rates that are unacceptably high in our contemporary era. Furthermore, mortality rates are associated with older age. Therefore, as the elderly population continues to increase in the United States, preoperative, perioperative, and postoperative measures must be taken to reduce this high morbidity and mortality rates.
    Source

    J Surg Res. 2017 Jul;215:108-113. doi: 10.1016/j.jss.2017.03.052. Epub 2017 Apr 6. Link to article on publisher's site

    DOI
    10.1016/j.jss.2017.03.052
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/50348
    PubMed ID
    28688634
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    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jss.2017.03.052
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