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Multicenter Study
. 2024 Aug;38(8):4402-4414.
doi: 10.1007/s00464-024-10881-0. Epub 2024 Jun 17.

Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study

Mohamed Abouelazayem  1   2   3 , Rajesh Jain  4 , Michael S J Wilson  5 , Alessandro Martinino  6 , Vignesh Balasubaramaniam  7 , Walter Biffl  8 , Federico Coccolini  9 , Manel Riera  10 , Himanshu Wadhawan  5 , Ishaan Wazir  11 , Bettahar Abderaouf  12 , Daniil Abramov  13 , Mustafa A Abu Jayyab  14 , Khayry Al-Shami  15 , Ahmad Alfarwan  16 , Faris M Alhajami  17 , Akram Alkaseek  18 , Ous Alozairi  19 , Ahmed Siddique Ammar  20 , Burak Atar  21 , Gan-Erdene Baatarjav  22 , Lovenish Bains  23 , Ashraf Bakri  24 , Nuru Bayramov  25 , Rajesh Bhojwani  26 , Gioia Brachini  27 , Giacomo Calini  28 , Michela Campanelli  29 , Shi Yu Cheng  30 , Charan Singh Choudhary  31 , Sharfuddin Chowdhury  32 , Elif Colak  33 , Jayanta Kumar Das  34 , Surrendar Dawani  35 , Turgut Dönmez  36 , Ibrahim Elzayat  37 , Sarnai Erdene  38 , Tashaba Qaiser Faizi  35 , Maximos Frountzas  39 , Besma Gafsi  40 , Paolo Gentileschi  29 , Mert Guler  41 , Gaurav Gupta  31 , Nour Elhouda Harkati  42 , Matthew Harris  43 , Doaa M Hasan  44 , Omorodion Omoruyi Irowa  45 , Salman Jafferi  35 , Sumita Agarwal Jain  31 , Lai Jun Han  46 , Satyanarayana Murthy Kandiboyina  47 , Mehmetu Karabulut  21 , Almu'atasim Khamees  15 , Shahzeb Khan  48 , Madiha Masood Khan  35 , Cheng Jing Khaw  30 , Michal Kisielewski  49 , Mohamad Klib  16 , Jurij A Košir  50 , Wiktor Jan Krawczyk  51 , Giorgio Lisi  52 , Jerry Godfrey Makama  53 , Baila Maqbool  54 , Cláudia Neves Marques  55 , Serhat Meric  56 , Mateusz Przemysław Mietła  51 , Alaa Mohamed Ads  57 , Joshua Muhumuza  58 , Francesk Mulita  59 , Matanat Mustafayeva  60 , Mohammed A Omar  61 , Taryel Omarov  25 , Akshant Anil Pathak  62 , Ratnadeep Paul  63 , Giovanna Pavone  64 , Mauro Podda  65 , Novinth Kumar Raja Ram  66 , Fatima Rauf  67 , Sidra Rauf  68 , Ahmed Mohamed Safy  61 , Erdene Sandag  38 , Ahmet Necati Şanlı  69 , Adeela Z Siddiqui  35 , Maria Sotiropoulou  70 , Vikash Talib  35 , Cihad Tatar  41 , Anuroop Thota  47 , Merve Tokocin  56 , Aditya Tolat  11 , Petar Angelov Uchikov  71 , José I Valenzuela  72 , Sunil Kumar Venkatappa  73 , Georgios-Ioannis Verras  59 , Ivan Vlahović  74 , Dafer Abdulhakim S Zreeg  75 , Victor Roth Cardoso  76   77 , Georgios V Gkoutos  76   77 , Rishi Singhal #  78 , Kamal Mahawar #  79 ; GRACE Study Collaborative Group
Collaborators, Affiliations
Multicenter Study

Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study

Mohamed Abouelazayem et al. Surg Endosc. 2024 Aug.

Abstract

Background: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these.

Method: We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality.

Results: 1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality.

Conclusions: This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.

Keywords: Gastrointestinal; Global surgery; Perforated peptic ulcer.

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