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Meta-Analysis
. 2020 Feb 17;7(1):e000350.
doi: 10.1136/bmjgast-2019-000350. eCollection 2020.

Risk factors of perioperative mortality from complicated peptic ulcer disease in Africa: systematic review and meta-analysis

Sarah Peiffer #  1 , Matthew Pelton #  1 , Laura Keeney  1 , Eustina G Kwon  1 , Richard Ofosu-Okromah  2 , Yubraj Acharya  3 , Vernon M Chinchilli  1 , David I Soybel  1 , John S Oh  1 , Paddy Ssentongo  1   4   5
Affiliations
Meta-Analysis

Risk factors of perioperative mortality from complicated peptic ulcer disease in Africa: systematic review and meta-analysis

Sarah Peiffer et al. BMJ Open Gastroenterol. .

Abstract

Introduction: In 2013, peptic ulcer disease (PUD) caused over 300 000 deaths globally. Low-income and middle-income countries are disproportionately affected. However, there is limited information regarding risk factors of perioperative mortality rates in these countries.

Objective: To assess perioperative mortality rates from complicated PUD in Africa and associated risk factors.

Design: We performed a systematic review and a random-effect meta-analysis of literature describing surgical management of complicated PUD in Africa. We used subgroup analysis and meta-regression analyses to investigate sources of variations in the mortality rates and to assess the risk factors contributing to mortality.

Results: From 95 published reports, 10 037 patients underwent surgery for complicated PUD. The majority of the ulcers (78%) were duodenal, followed by gastric (14%). Forty-one per cent of operations were for perforation, 22% for obstruction and 9% for bleeding. The operations consisted of vagotomy (38%), primary repair (34%), resection and reconstruction (12%), and drainage procedures (6%). The overall PUD mortality rate was 6.6% (95% CI 5.4% to 8.1%). It increased to 9.7% (95% CI 7.1 to 13.0) when we limited the analysis to studies published after the year 2000. The correlation was higher between perforated PUD and mortality rates (r=0.41, p<0.0001) than for bleeding PUD and mortality rates (r=0.32, p=0.001). Non-significant differences in mortality rates existed between sub-Saharan Africa (SSA) and North Africa and within SSA.

Conclusion: Perioperative mortality rates from complicated PUD in Africa are substantially high and could be increasing over time, and there are possible regional differences.

Keywords: Africa; bleeding; obstruction; peptic ulcer disease; perforation.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PreferredReporting Items for Systematic Reviews and Meta-Analyses flowchart of a systematic review of peptic ulcer disease mortality in Africa.
Figure 2
Figure 2
Distribution of the number of articles analysed.
Figure 3
Figure 3
Distribution of the perioperative peptic ulcer disease mortality rates in Africa.
Figure 4
Figure 4
Overall pooled peptic ulcer disease mortality rates (%) in Africa.
Figure 5
Figure 5
Pooled peptic ulcer disease mortality rates (%) in Africa stratified by publication year.
Figure 6
Figure 6
Country-specific peptic ulcer disease mortality rates (%) in Africa.
Figure 7
Figure 7
Subregion-specific peptic ulcer disease mortality rates (%) in Africa.
Figure 8
Figure 8
Region-specific peptic ulcer disease mortality rates (%) in Africa.
Figure 9
Figure 9
Correlation of peptic ulcer disease mortality rates and risk factors/covariates. (A) Duodenal ulcers. (B) Gastric ulcers. (C) Bleeding ulcers. (D) Perforated ulcers. (E) Publication year. (F) Age at surgery.
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