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Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia

Moses, J. Fallah; Hughes, Christopher D.; Patel, Pratik B.; Chao, Tiffany E.; Konneh, Solomane A.; Jallabah, Torsou Y.; Kikubaire, Michael Kiiza; Meara, John G. and Hagander, Lars LU (2015) In African Journal of Emergency Medicine 5(2). p.60-65
Abstract
Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes. Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia, Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors... (More)
Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes. Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia, Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality. Results Median age was 33 years and 85% were males. A majority of the patients (70%) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5 days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35%. Median length of stay among survivors was 16 days, and death occurred at median 1 day after admission. Long symptom duration and age >30 years of age were significantly associated with in-hospital mortality on univariate (β = 2.60 [0.18–5.03], p = 0.035) and multivariate testing (β = 2.95 [0.02–5.88], p = 0.049). Conclusion Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series, surgical treatment for perforated peptic ulcer disease carried a high mortality, and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Surgery, Resource-limited settings, Outcomes, Mortality, Perforated peptic ulcer, Liberia
in
African Journal of Emergency Medicine
volume
5
issue
2
pages
60 - 65
publisher
Elsevier
external identifiers
  • wos:000366636000006
  • scopus:84930086894
ISSN
2211-419X
DOI
10.1016/j.afjem.2014.11.002
language
English
LU publication?
yes
id
7307212d-a4aa-4357-95d2-f8fddc8e0dbd (old id 5466080)
alternative location
http://www.sciencedirect.com/science/article/pii/S2211419X14001384
date added to LUP
2015-06-08 12:40:31
date last changed
2017-06-20 13:54:43
@article{7307212d-a4aa-4357-95d2-f8fddc8e0dbd,
  abstract     = {Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes. Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia, Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality. Results Median age was 33 years and 85% were males. A majority of the patients (70%) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5 days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35%. Median length of stay among survivors was 16 days, and death occurred at median 1 day after admission. Long symptom duration and age >30 years of age were significantly associated with in-hospital mortality on univariate (β = 2.60 [0.18–5.03], p = 0.035) and multivariate testing (β = 2.95 [0.02–5.88], p = 0.049). Conclusion Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series, surgical treatment for perforated peptic ulcer disease carried a high mortality, and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries.},
  author       = {Moses, J. Fallah and Hughes, Christopher D. and Patel, Pratik B. and Chao, Tiffany E. and Konneh, Solomane A. and Jallabah, Torsou Y. and Kikubaire, Michael Kiiza and Meara, John G. and Hagander, Lars},
  issn         = {2211-419X},
  keyword      = {Surgery,Resource-limited settings,Outcomes,Mortality,Perforated peptic ulcer,Liberia},
  language     = {eng},
  number       = {2},
  pages        = {60--65},
  publisher    = {Elsevier},
  series       = {African Journal of Emergency Medicine},
  title        = {Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia},
  url          = {http://dx.doi.org/10.1016/j.afjem.2014.11.002},
  volume       = {5},
  year         = {2015},
}