Study: Every Hour of Surgical Delay Brings a Perforated Peptic Ulcer Patient Closer to Death

Though it’s common medical knowledge that an ulcer eating a hole through a patient’s stomach requires immediate surgical treatment as a result of its life-threatening nature, new findings from a team of Danish researchers urge physicians to beat the clock in performing emergency surgery on perforated peptic ulcers (PPU).

For their “Surgical Delay Is a Critical Determinant of Survival in Perforated Peptic Ulcer” study published online ahead of print in the British Journal of Surgery on June 10, 2013, investigators from the Departments of Anesthesiology and Intensive Care Medicine at Copenhagen University Hospital examined a large cohort of 2,668 patients surgically treated for PPU in Denmark between February 1, 2003 and August 31, 2009, excluding those with malignant ulcers. Roughly 55 percent of the study cohort, or 1,478 patients, were female, and approximately 67.5 percent, or 1,800 patients, presented a comorbid disease.

Focusing on 30-day survival rates, the researchers discovered that a total of 708 patients, or 26.5 percent of the study cohort, had died within a month of surgery. After calculating how surgical delay impacted each patient’s post-PPU outcome in terms of mortality, the investigators concluded that “every hour of delay from admission to surgery was associated with an adjusted 2.4 percent decreased probability of survival compared with the previous hour.” Therefore, “limiting surgical delay in patients with PPU seems of paramount importance,” the authors wrote.

While surgical delay had previously been established as a negative prognostic factor in PPU, the present researchers noted that earlier evidence originated from studies with a “high risk of bias,” which is why the authors presented their data on the association between hourly surgical delay and 30-day survival probability with 95 percent confidence intervals.