Surgical delay is a critical determinant of survival in perforated peptic ulcer
Background Morbidity and mortality following perforated peptic ulcer (PPU) remain substantial. Surgical delay is a well established negative prognostic factor, but evidence derives from studies with a high risk of bias. The aim of the present nationwide cohort study was to evaluate the adjusted effe...
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| Veröffentlicht in: | British journal of surgery 2013-07, Vol.100 (8), p.1045-1049 |
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| creator | Buck, D. L. Vester-Andersen, M. Møller, M. H. |
| description | Background
Morbidity and mortality following perforated peptic ulcer (PPU) remain substantial. Surgical delay is a well established negative prognostic factor, but evidence derives from studies with a high risk of bias. The aim of the present nationwide cohort study was to evaluate the adjusted effect of hourly surgical delay on survival after PPU.
Methods
This was a cohort study including all Danish patients treated surgically for PPU between 1 February 2003 and 31 August 2009. Medically treated patients and those with a malignant ulcer were excluded. The associations between surgical delay and 30‐day survival are presented as crude and adjusted relative risks (RRs) with 95 per cent confidence intervals (c.i.).
Results
A total of 2668 patients were included. Their median age was 70·9 (range 16·2–104·2) years and 55·4 per cent (1478 of 2668) were female. Some 67·5 per cent of the patients (1800 of 2668) had at least one of six co‐morbid diseases and 45·6 per cent had an American Society of Anesthesiologists fitness grade of III or more. A total of 708 patients (26·5 per cent) died within 30 days of surgery. Every hour of delay from admission to surgery was associated with an adjusted 2·4 per cent decreased probability of survival compared with the previous hour (adjusted RR 1·024, 95 per cent c.i. 1·011 to 1·037).
Conclusion
Limiting surgical delay in patients with PPU seems of paramount importance.
Minimize delay before surgery |
| doi_str_mv | 10.1002/bjs.9175 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1366821628</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1366821628</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4545-7591448800fd4629d596d3ec5c8e34603c50715c604c0d93cd703bf288322ce03</originalsourceid><addsrcrecordid>eNpd0UtLw0AQB_BFFFsf4CeQgBcv0dlnkqMW37UeVJRelu1mI1vTpO4m1X57N1greJpl5sewzB-hAwwnGICcTqb-JMMJ30B9TAWPCRbpJuoDQBJjSmgP7Xg_BcAUONlGPUITzgTjffTw2Lo3q1UZ5aZUy8j6SEXa2WbVa4yb2UpVTVQXkW_dwi5C31bR3LiidqoxeXjOA4_aUhu3h7YKVXqzv6q76Pny4mlwHQ8frm4GZ8NYM854nPAMM5amAEXOBMlynomcGs11aigTQDWHBHMtgGnIM6rzBOikIGlKCdEG6C46_tk7d_VHa3wjZ9ZrU5aqMnXrZTiDSMMZSBro0T86rVtXhd91imcJxbRThyvVTmYml3NnZ8ot5e-pAoh_wKctzXI9xyC7CGSIQHYRyPPbx67-eesb87X2yr1LkYSl8mV0JV_v4W50Ph7LAf0GXqKFPg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1365973138</pqid></control><display><type>article</type><title>Surgical delay is a critical determinant of survival in perforated peptic ulcer</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Buck, D. L. ; Vester-Andersen, M. ; Møller, M. H.</creator><creatorcontrib>Buck, D. L. ; Vester-Andersen, M. ; Møller, M. H. ; Danish Clinical Register of Emergency Surgery</creatorcontrib><description>Background
Morbidity and mortality following perforated peptic ulcer (PPU) remain substantial. Surgical delay is a well established negative prognostic factor, but evidence derives from studies with a high risk of bias. The aim of the present nationwide cohort study was to evaluate the adjusted effect of hourly surgical delay on survival after PPU.
Methods
This was a cohort study including all Danish patients treated surgically for PPU between 1 February 2003 and 31 August 2009. Medically treated patients and those with a malignant ulcer were excluded. The associations between surgical delay and 30‐day survival are presented as crude and adjusted relative risks (RRs) with 95 per cent confidence intervals (c.i.).
Results
A total of 2668 patients were included. Their median age was 70·9 (range 16·2–104·2) years and 55·4 per cent (1478 of 2668) were female. Some 67·5 per cent of the patients (1800 of 2668) had at least one of six co‐morbid diseases and 45·6 per cent had an American Society of Anesthesiologists fitness grade of III or more. A total of 708 patients (26·5 per cent) died within 30 days of surgery. Every hour of delay from admission to surgery was associated with an adjusted 2·4 per cent decreased probability of survival compared with the previous hour (adjusted RR 1·024, 95 per cent c.i. 1·011 to 1·037).
Conclusion
Limiting surgical delay in patients with PPU seems of paramount importance.
Minimize delay before surgery</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.9175</identifier><identifier>PMID: 23754645</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Denmark - epidemiology ; Duodenal Ulcer - mortality ; Duodenal Ulcer - surgery ; Female ; Humans ; Male ; Middle Aged ; Peptic Ulcer Perforation - mortality ; Peptic Ulcer Perforation - surgery ; Risk Factors ; Stomach Ulcer - mortality ; Stomach Ulcer - surgery ; Time-to-Treatment ; Treatment Outcome ; Young Adult</subject><ispartof>British journal of surgery, 2013-07, Vol.100 (8), p.1045-1049</ispartof><rights>2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd</rights><rights>2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4545-7591448800fd4629d596d3ec5c8e34603c50715c604c0d93cd703bf288322ce03</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.9175$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.9175$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23754645$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Buck, D. L.</creatorcontrib><creatorcontrib>Vester-Andersen, M.</creatorcontrib><creatorcontrib>Møller, M. H.</creatorcontrib><creatorcontrib>Danish Clinical Register of Emergency Surgery</creatorcontrib><title>Surgical delay is a critical determinant of survival in perforated peptic ulcer</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
Morbidity and mortality following perforated peptic ulcer (PPU) remain substantial. Surgical delay is a well established negative prognostic factor, but evidence derives from studies with a high risk of bias. The aim of the present nationwide cohort study was to evaluate the adjusted effect of hourly surgical delay on survival after PPU.
Methods
This was a cohort study including all Danish patients treated surgically for PPU between 1 February 2003 and 31 August 2009. Medically treated patients and those with a malignant ulcer were excluded. The associations between surgical delay and 30‐day survival are presented as crude and adjusted relative risks (RRs) with 95 per cent confidence intervals (c.i.).
Results
A total of 2668 patients were included. Their median age was 70·9 (range 16·2–104·2) years and 55·4 per cent (1478 of 2668) were female. Some 67·5 per cent of the patients (1800 of 2668) had at least one of six co‐morbid diseases and 45·6 per cent had an American Society of Anesthesiologists fitness grade of III or more. A total of 708 patients (26·5 per cent) died within 30 days of surgery. Every hour of delay from admission to surgery was associated with an adjusted 2·4 per cent decreased probability of survival compared with the previous hour (adjusted RR 1·024, 95 per cent c.i. 1·011 to 1·037).
Conclusion
Limiting surgical delay in patients with PPU seems of paramount importance.
Minimize delay before surgery</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cohort Studies</subject><subject>Denmark - epidemiology</subject><subject>Duodenal Ulcer - mortality</subject><subject>Duodenal Ulcer - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Peptic Ulcer Perforation - mortality</subject><subject>Peptic Ulcer Perforation - surgery</subject><subject>Risk Factors</subject><subject>Stomach Ulcer - mortality</subject><subject>Stomach Ulcer - surgery</subject><subject>Time-to-Treatment</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0UtLw0AQB_BFFFsf4CeQgBcv0dlnkqMW37UeVJRelu1mI1vTpO4m1X57N1greJpl5sewzB-hAwwnGICcTqb-JMMJ30B9TAWPCRbpJuoDQBJjSmgP7Xg_BcAUONlGPUITzgTjffTw2Lo3q1UZ5aZUy8j6SEXa2WbVa4yb2UpVTVQXkW_dwi5C31bR3LiidqoxeXjOA4_aUhu3h7YKVXqzv6q76Pny4mlwHQ8frm4GZ8NYM854nPAMM5amAEXOBMlynomcGs11aigTQDWHBHMtgGnIM6rzBOikIGlKCdEG6C46_tk7d_VHa3wjZ9ZrU5aqMnXrZTiDSMMZSBro0T86rVtXhd91imcJxbRThyvVTmYml3NnZ8ot5e-pAoh_wKctzXI9xyC7CGSIQHYRyPPbx67-eesb87X2yr1LkYSl8mV0JV_v4W50Ph7LAf0GXqKFPg</recordid><startdate>201307</startdate><enddate>201307</enddate><creator>Buck, D. L.</creator><creator>Vester-Andersen, M.</creator><creator>Møller, M. H.</creator><general>John Wiley & Sons, Ltd</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201307</creationdate><title>Surgical delay is a critical determinant of survival in perforated peptic ulcer</title><author>Buck, D. L. ; Vester-Andersen, M. ; Møller, M. H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4545-7591448800fd4629d596d3ec5c8e34603c50715c604c0d93cd703bf288322ce03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cohort Studies</topic><topic>Denmark - epidemiology</topic><topic>Duodenal Ulcer - mortality</topic><topic>Duodenal Ulcer - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Peptic Ulcer Perforation - mortality</topic><topic>Peptic Ulcer Perforation - surgery</topic><topic>Risk Factors</topic><topic>Stomach Ulcer - mortality</topic><topic>Stomach Ulcer - surgery</topic><topic>Time-to-Treatment</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Buck, D. L.</creatorcontrib><creatorcontrib>Vester-Andersen, M.</creatorcontrib><creatorcontrib>Møller, M. H.</creatorcontrib><creatorcontrib>Danish Clinical Register of Emergency Surgery</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Buck, D. L.</au><au>Vester-Andersen, M.</au><au>Møller, M. H.</au><aucorp>Danish Clinical Register of Emergency Surgery</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical delay is a critical determinant of survival in perforated peptic ulcer</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2013-07</date><risdate>2013</risdate><volume>100</volume><issue>8</issue><spage>1045</spage><epage>1049</epage><pages>1045-1049</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background
Morbidity and mortality following perforated peptic ulcer (PPU) remain substantial. Surgical delay is a well established negative prognostic factor, but evidence derives from studies with a high risk of bias. The aim of the present nationwide cohort study was to evaluate the adjusted effect of hourly surgical delay on survival after PPU.
Methods
This was a cohort study including all Danish patients treated surgically for PPU between 1 February 2003 and 31 August 2009. Medically treated patients and those with a malignant ulcer were excluded. The associations between surgical delay and 30‐day survival are presented as crude and adjusted relative risks (RRs) with 95 per cent confidence intervals (c.i.).
Results
A total of 2668 patients were included. Their median age was 70·9 (range 16·2–104·2) years and 55·4 per cent (1478 of 2668) were female. Some 67·5 per cent of the patients (1800 of 2668) had at least one of six co‐morbid diseases and 45·6 per cent had an American Society of Anesthesiologists fitness grade of III or more. A total of 708 patients (26·5 per cent) died within 30 days of surgery. Every hour of delay from admission to surgery was associated with an adjusted 2·4 per cent decreased probability of survival compared with the previous hour (adjusted RR 1·024, 95 per cent c.i. 1·011 to 1·037).
Conclusion
Limiting surgical delay in patients with PPU seems of paramount importance.
Minimize delay before surgery</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>23754645</pmid><doi>10.1002/bjs.9175</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of surgery, 2013-07, Vol.100 (8), p.1045-1049 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adolescent Adult Aged Aged, 80 and over Cohort Studies Denmark - epidemiology Duodenal Ulcer - mortality Duodenal Ulcer - surgery Female Humans Male Middle Aged Peptic Ulcer Perforation - mortality Peptic Ulcer Perforation - surgery Risk Factors Stomach Ulcer - mortality Stomach Ulcer - surgery Time-to-Treatment Treatment Outcome Young Adult |
| title | Surgical delay is a critical determinant of survival in perforated peptic ulcer |
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