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Predictors of mortality for perforated peptic ulcer disease in Malawi

Published:November 24, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.11.029

      Highlights

      • Perforated peptic ulcer disease confers a 22% crude mortality in Malawi.
      • Patients with perforated peptic ulcer disease present quickly to medical attention.
      • In-hospital delay to surgery is a significant predictor of mortality.

      Abstract

      Background

      Mortality from perforated peptic ulcer disease (PUD) remains high, especially in sub-Saharan Africa. We sought to identify predictors of mortality following surgery for perforated PUD.

      Methods

      We performed a retrospective study of acute care surgeries at Kamuzu Central Hospital (KCH) in Malawi from 2013 to 2022. Patients undergoing omental patch surgeries were included. Bivariate and multivariate analyses were used to model predictors of mortality.

      Results

      A total of 248 patients were included. The mean age was 30 ± 15 years. Ninety percent were male. Mortality rate was 22.2%. Predictors of mortality included age (adjusted odds ratio [AOR] 1.06, 95% confidence interval [CI] 1.03–1.09), shock index (AOR 1.86, 95% CI 1.14–3.03), days to operative intervention (AOR 1.44, 95% CI 1.10–1.88), and presence of complications (AOR 9.65, 95% CI 3.79–24.6).

      Conclusions

      Mortality following surgery for perforated PUD remains high in this low-resource environment. In-hospital delay is a significant and modifiable predictor of mortality.

      Keywords

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