Factors Influencing Morbidity and Mortality Following Emergency Surgery for Perforated Peptic Ulcer Disease: A Prospective Observational Study.

Abstract

Background: Perforated peptic ulcer disease (PPUD) remains one of the most lethal surgical emergencies encountered in general surgical practice, with reported mortality rates ranging between 10% and 25%. Identification of modifiable and non-modifiable prognostic determinants is essential for risk stratification and improvement of postoperative outcomes. Objectives: To determine the incidence, clinical spectrum, and postoperative outcomes of PPUD, and to identify preoperative and intraoperative variables independently associated with postoperative morbidity and mortality. Methods: A prospective observational study was conducted at the Department of General Surgery, Sapthagiri Institute of Medical Sciences and Research Centre (SIMSRC), Chikkabanavara, Bengaluru, over a two-month period from 28 April 2026 to 30 June 2026. Forty-five consecutive patients aged ≥18 years diagnosed with perforated peptic ulcer and undergoing emergency laparotomy were enrolled. Demographic, clinical, biochemical, operative, and outcome variables were recorded. The Boey score and ASA physical status were used for preoperative risk stratification. Data were analysed using SPSS version 26.0; the chi-square test, Fisher’s exact test, Student’s t-test, and multivariable logistic regression were applied, with a p-value <0.05 considered statistically significant. Results: The mean age of the cohort was 48.5 ± 14.2 years, with a marked male preponderance (84.4%). Duodenal perforation accounted for 77.8% of cases, and Graham’s omentopexy was the predominant procedure (86.7%). Overall morbidity was 40.0% (18/45) and mortality was 11.1% (5/45). Surgical site infection (26.7%) was the most frequent complication. On univariate analysis, age >60 years (p=0.021), delayed presentation beyond 24 hours (p=0.008), preoperative shock (p<0.001), Boey score ≥2 (p<0.001), ASA grade ≥III (p=0.003), serum albumin <2.5 g/dL (p=0.014), and perforation size >10 mm (p=0.019) were significantly associated with adverse outcomes. On multivariable logistic regression, preoperative shock (adjusted OR 8.6; 95% CI 1.8–41.2; p=0.007) and Boey score ≥2 (adjusted OR 6.4; 95% CI 1.5–27.9; p=0.013) remained independent predictors of mortality. Conclusion: Timely referral, aggressive resuscitation, and early operative intervention remain the cornerstones of management in PPUD. The Boey score and ASA grade are simple, reliable tools that identify high-risk patients likely to benefit from intensive perioperative care