M H Møller1, S Adamsen, R W Thomsen, A M Møller. 1. Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev, Herlev, Denmark. mortenhylander@gmail.com
Abstract
BACKGROUND: Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU. METHODS: This was an externally controlled multicentre trial set in seven gastrointestinal departments in Denmark. Consecutive patients who underwent surgery for gastric or duodenal PPU between 1 January 2008 and 31 December 2009 were treated according to a multimodal and multidisciplinary evidence-based perioperative care protocol. The 30-day mortality rate in this group was compared with rates in historical and concurrent national controls. RESULTS: The 30-day mortality rate following PPU was 17·1 per cent in the intervention group, compared with 27·0 per cent in the three control groups (P = 0·005). This corresponded to a relative risk of 0·63 (95 per cent confidence interval 0·41 to 0·97), a relative risk reduction of 37 (5 to 58) per cent and a number needed to treat of 10 (6 to 38). CONCLUSION: The 30-day mortality rate in patients with PPU was reduced by more than one-third after the implementation of a multimodal and multidisciplinary perioperative care protocol, compared with conventional treatment. REGISTRATION NUMBER: NCT00624169 (http://www.clinicaltrials.gov).
BACKGROUND: Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU. METHODS: This was an externally controlled multicentre trial set in seven gastrointestinal departments in Denmark. Consecutive patients who underwent surgery for gastric or duodenal PPU between 1 January 2008 and 31 December 2009 were treated according to a multimodal and multidisciplinary evidence-based perioperative care protocol. The 30-day mortality rate in this group was compared with rates in historical and concurrent national controls. RESULTS: The 30-day mortality rate following PPU was 17·1 per cent in the intervention group, compared with 27·0 per cent in the three control groups (P = 0·005). This corresponded to a relative risk of 0·63 (95 per cent confidence interval 0·41 to 0·97), a relative risk reduction of 37 (5 to 58) per cent and a number needed to treat of 10 (6 to 38). CONCLUSION: The 30-day mortality rate in patients with PPU was reduced by more than one-third after the implementation of a multimodal and multidisciplinary perioperative care protocol, compared with conventional treatment. REGISTRATION NUMBER: NCT00624169 (http://www.clinicaltrials.gov).
Authors: Kenneth Thorsen; Jon Arne Søreide; Jan Terje Kvaløy; Tom Glomsaker; Kjetil Søreide Journal: World J Gastroenterol Date: 2013-01-21 Impact factor: 5.742
Authors: André Pereira; Hugo Santos Sousa; Diana Gonçalves; Eduardo Lima da Costa; André Costa Pinho; Elisabete Barbosa; José Barbosa Journal: Minim Invasive Surg Date: 2021-05-12
Authors: Morten Vester-Andersen; Tina Waldau; Jørn Wetterslev; Morten Hylander Møller; Jacob Rosenberg; Lars Nannestad Jørgensen; Inger Gillesberg; Henrik Loft Jakobsen; Egon Godthåb Hansen; Lone Musaeus Poulsen; Jan Skovdal; Ellen Kristine Søgaard; Morten Bestle; Jesper Vilandt; Iben Rosenberg; Rasmus Ehrenfried Berthelsen; Jens Pedersen; Mogens Rørbæk Madsen; Thomas Feurstein; Malene Just Busse; Johnny D H Andersen; Christian Maschmann; Morten Rasmussen; Christian Jessen; Lasse Bugge; Helle Ørding; Ann Merete Møller Journal: Trials Date: 2013-02-02 Impact factor: 2.279