Khalid Munir, Javaid Iqbal, Muhammad Zulfiqar Ali, Afshan Khalid, Umar Mushtaq, Kashif Nadeem.
Factor responsible for higher complication rate in patients operated for perforated peptic ulcer.
J Sheikh Zayed Med Coll Jan ;2(2):160-4.

Background: Perforation of peptic ulcer is a life-threatening emergency and associated with marked post surgical morbidity. Objective: To enlist the predictors of the postoperative morbidity in surgically treated patients of perforated peptic ulcer. Methods: A cross sectional study was conducted at Surgical Departments of Allied & DHQ Hospital Faisalabad. Clinically and radiologically suggestive but surgically proven, 60 cases of the perforated peptic ulcer were included in the study. Possible predictors were recorded on admission as well as during surgery. Postoperatively, patients were taken care of and followed up for the development of complication till the time of discharge. Depending upon the presence/ absence of the post operative complications, patients were divided into two groups. Data was entered and analyzed by using SPSS version 11. Results: In our study, age ranged from 24-80 years. 26.7 percent of the cases had clinical features of shock at presentation. Smoking was noted in 47 percent of the cases. In 97% of the cases, the size of perforation was less than 1 cm while more than half of the cases had amount of peritoneal spillage more than 1 Litre. The most common complication was wound infection. Most of the patients were discharged home between the 7th and 10th postoperative days. Age more than 40 and male sex (p-value < 0.147) were not found to be associated with increased risk of development of the post operative complication. Complication rate was found to be quite high for the patients presenting after 72 hours of the development of the pain (p=0.006, OR=9.3). Other factors which showed significant difference between the two groups for the development of complication included shock at presentation ( p-value= 0.032), history of smoking (p-value= 0.002) and the presence of associated medical illness (p-value= 0.01). Conclusions: Late presentation, history of smoking, presence of shock at the time of presentation and presence of the associated medical illness significantly influence the rate of development of post operative complications.

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