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.
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.
Authors: Frank Bloos; Hendrik Rüddel; Daniel Thomas-Rüddel; Daniel Schwarzkopf; Christine Pausch; Stephan Harbarth; Torsten Schreiber; Matthias Gründling; John Marshall; Philipp Simon; Mitchell M Levy; Manfred Weiss; Andreas Weyland; Herwig Gerlach; Tobias Schürholz; Christoph Engel; Claudia Matthäus-Krämer; Christian Scheer; Friedhelm Bach; Reimer Riessen; Bernhard Poidinger; Karin Dey; Norbert Weiler; Andreas Meier-Hellmann; Helene H Häberle; Gabriele Wöbker; Udo X Kaisers; Konrad Reinhart Journal: Intensive Care Med Date: 2017-05-02 Impact factor: 17.440
Authors: Daniel I McIsaac; Karim Abdulla; Homer Yang; Sudhir Sundaresan; Paula Doering; Sandeep Green Vaswani; Kednapa Thavorn; Alan J Forster Journal: CMAJ Date: 2017-07-10 Impact factor: 8.262
Authors: Andrew Rhodes; Laura E Evans; Waleed Alhazzani; Mitchell M Levy; Massimo Antonelli; Ricard Ferrer; Anand Kumar; Jonathan E Sevransky; Charles L Sprung; Mark E Nunnally; Bram Rochwerg; Gordon D Rubenfeld; Derek C Angus; Djillali Annane; Richard J Beale; Geoffrey J Bellinghan; Gordon R Bernard; Jean-Daniel Chiche; Craig Coopersmith; Daniel P De Backer; Craig J French; Seitaro Fujishima; Herwig Gerlach; Jorge Luis Hidalgo; Steven M Hollenberg; Alan E Jones; Dilip R Karnad; Ruth M Kleinpell; Younsuk Koh; Thiago Costa Lisboa; Flavia R Machado; John J Marini; John C Marshall; John E Mazuski; Lauralyn A McIntyre; Anthony S McLean; Sangeeta Mehta; Rui P Moreno; John Myburgh; Paolo Navalesi; Osamu Nishida; Tiffany M Osborn; Anders Perner; Colleen M Plunkett; Marco Ranieri; Christa A Schorr; Maureen A Seckel; Christopher W Seymour; Lisa Shieh; Khalid A Shukri; Steven Q Simpson; Mervyn Singer; B Taylor Thompson; Sean R Townsend; Thomas Van der Poll; Jean-Louis Vincent; W Joost Wiersinga; Janice L Zimmerman; R Phillip Dellinger Journal: Intensive Care Med Date: 2017-01-18 Impact factor: 17.440