A study of factors associated with mortality in patients managed for perforated peptic ulcers at University Teaching Hospital, Lusaka, Zambia
Date
2019
Authors
Nyimbili, Edward, N.
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
Perforated Peptic ulcers (PPU) is one of the common finding in patients undergoing emergency
laparotomy for peritonitis at UTH, Adult Hospital, department of surgery, representing about
26.45% of these cases in a calendar year. A high risk of mortality and morbidity is encountered in
patients treated with surgery for PPU. Patient stratification and appropriate management according
to patients risk of mortality, has been recommended as a way of trying to improve outcomes in
patients with PPU. The aim of the study was to investigate the factors associated with mortality in
patients that present with PPU managed surgically at UTH. This was a prospective cohort study,
conducted at UTH-Adult Hospital, Department of surgery targeting patients with PPU that had
undergone emergency laparotomy. They were enrolled using interview administered
questionnaire and followed up for 30-days post-operation. The primary outcome was 30 day postoperation
mortality. The study enrolled 38 participants of which 35 participants met the inclusion
criteria, 88.57% (n=31) male and 11.43% (n=4) female. The age ranged from 14 years to 84 years
with the mode age ranges 20 years – 30 years and 40 years – 50 years. Most patients presented
with two (2) or more complaints. Abdominal pain was common presenting complaint in all the
patients and other complaints included, nausea and vomiting, abdominal distension and
constipation. 82.86% (n=29) of the participants presented after 24 hours of onset of symptoms,
17.14% (n=6) were HIV positive and 42.86% (n=15) were in shock on presentation. More than
half of the participants were assessed as ASA score III or greater. On admission 40.00 % (n=14)
had elevated serum creatinine and 37.1 % (n=13) had low serum albumin. 91.43% (n=32) of PPU
were gastric perforations and 8.57 % (n=3) duodenal perforations and the mode and median range
of size of perforation was 5mm – 10mm. Length of hospital stay ranged from one(1) day to 13
days with a mean of 7.29 days. 30-day post-operation mortality was 34.29% and 40% of the
participants developed a post operation complication. Univariate binary regression analysis found
Age, ASA score, Serum creatinine, and Size of perforation to be significantly associated with
mortality (p-value <0.05, C.I. 95%). Univariate linear regression analysis found HIV positive
Status, and CD4 cell count level to be significantly associated with mortality(p-value <0.05; 95%
C.I.). Multivariate binary regression analysis found no significant association with mortality of the
above variables (p-value <0.05; C.I. 95%). PPU is a common finding among patients with
peritonitis undergoing emergency surgery at UTH and is associated with high mortality. Univariate
statistical analysis found Age, ASA score, Serum creatinine, Size of peptic ulcer perforation, HIV
Status and CD4 cell count level to be associated with mortality. However, no factor was found to
be significantly associated with mortality on multivariate regression analysis.
KEY WORDS: PPU, 30-Day post-operation Mortality, Laparotomy
Description
Thesis
Keywords
Peptic ulcer--surgery--Zambia , Peptic ulcer perforation