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 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 center dot 9 (range 16 center dot 2-104 center dot 2) years and 55 center dot 4 per cent (1478 of 2668) were female. Some 67 center dot 5 per cent of the patients (1800 of 2668) had at least one of six co-morbid diseases and 45 center dot 6 per cent had an American Society of Anesthesiologists fitness grade of III or more. A total of 708 patients (26 center dot 5 per cent) died within 30 days of surgery. Every hour of delay from admission to surgery was associated with an adjusted 2 center dot 4 per cent decreased probability of survival compared with the previous hour (adjusted RR 1 center dot 024, 95 per cent c.i. 1 center dot 011 to 1 center dot 037). Conclusion Limiting surgical delay in patients with PPU seems of paramount importance.