Background: Peptic ulcer is one of the most common diseases among Indian population. It can lead to several complications such as perforation, bleeding, etc., which require prompt diagnosis and treatment to reduce mortality and morbidity. This study aims to stratify the risk in patients with peptic ulcer perforation (PULP) using the PULP score.
Materials and methods: It is a single-center prospective observational study conducted for a period of 1½ years with data collection for 1 year and analysis and write-up for 6 months (June 2017–November 2018). The study involved patients who underwent emergency surgery for perforated peptic ulcer (PPU). The PULP score and the perforation operation time interval are applied to all patients and their outcome is studied.
Results: A total of 71 patients were included in the study; 6 patients died with a mortality rate of 8.5%. The mean PULP score in patients who expired was found to be 9. Complications occurred in 21 patients and the most common complication being the postoperative wound-site infection and acute respiratory distress syndrome (ARDS), which were significantly found in patients with the perforation operation time interval more than 24 hours.
Conclusion: The PULP score is a reliable predictor of morbidity and mortality in patients who were operated for PULPs. The perforation operation time interval is a significant factor in predicting the mortality, complications, and the duration of hospital stay.
Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, et al. Schwartz’s principles of surgery, 10e. McGraw-Hill; 2014. pp. 1034–1099.
Lui FY, Davis KA. Gastroduodenal perforation: maximal or minimal intervention? Scand J Surg 2010;99(2):73–77. DOI: 10.1177/145749691009900205.
Thorsen K, Søreide JA, Søreide K. Scoring systems for outcome prediction in patients with perforated peptic ulcer. Scand J Trauma Resusc Emerg Med 2013;21:25. DOI: 10.1186/1757-7241-21-25.
Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg 2009;33(1):80–85. DOI: 10.1007/s00268-008-9796-1.
Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996;77(2):217–222. DOI: 10.1093/bja/77.2.217.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818–829. DOI: 10.1097/00003246-198510000-00009.
Notash AY, Salimi J, Rahimian H, Fesharaki MS, Abbasi A. Evaluation of Mannheim peritonitis index and multiple organ failure score in patients with peritonitis. Indian J Gastroenterol 2005;24(5):197–200.
Thorsen K, Søreide JA, Søreide K. What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. J Gastrointest Surg 2014;18(7):1261–1268. DOI: 10.1007/s11605-014-2485-5.
Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg 1987;205(1):22–26. DOI: 10.1097/00000658-198701000-00005.
Møller MH, Adamsen S, Thomsen RW, Møller AM. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol 20101;45(7–8):785–805. DOI: 10.3109/00365521003783320.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008;34(1):17–60. DOI: 10.1007/s00134-007-0934-2.
Møller MH, Adamsen S, Thomsen RW, Møller AM. Peptic ulcer perforation (PULP) trial group. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg 2011;98(6):802–810. DOI: 10.1002/bjs.7429.
Møller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW. The peptic ulcer perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand 2012;56(5):655–662. DOI: 10.1111/j.1399-6576.2011.02609.x.
Møller MH, Vester-Andersen M, Thomsen RW. Long-term mortality following peptic ulcer perforation in the PULP trial. A nationwide follow-up study. Scand J Gastroenterol 2013;48(2):168–175. DOI: 10.3109/00365521.2012.746393.
Mishra A, Sharma D, Raina VK. A simplified prognostic scoring system for peptic ulcer perforation in developing countries. Indian J Gastroenterol 2003;22(2):49–53.
Møller MH, Adamsen S, Wøjdemann M, Møller AM. Perforated peptic ulcer: how to improve outcome? Scand J Gastroenterol 2009;44(1):15–22. DOI: 10.1080/00365520802307997.