Profiles and Predictive Factors for Poor Outcomes in Patients Managed Surgically for Perforated Peptic Ulcer Disease at Kenyatta National Hospital.

Abstract

Background: Perforated peptic ulcer (PPU) is a complication of peptic ulcer disease (PUD) that bears a high rate of morbidity and mortality. Scanty data is available in our setup on PPU and the outcomes of surgical management of these patients have been shown to vary from region to region. This study is conducted to establish the patient profiles at presentation as well as operative factors vis a vis the surgical outcomes with an aim of identifying factors that significantly predict outcome in our set up. Objective: To assess patient profiles and determine factors predictive of poor outcomes in patients managed surgically for perforated peptic ulcer disease in Kenyatta National Hospital (KNH). Methods: This was a Retrospective Cross-sectional Study involving 88 records of PPU patients operated on at KNH from Jan 2014 to Dec 2020. Data was collected from medical records retrieved at the KNH records department using a pre-formed data extraction tool. Patient profile factors were evaluated as at presentation and then the peri-operative factors as recorded in the surgical notes. Outcomes analyzed in this study were the rate of post operative complications and mortality. Results: There were more males (91.1%) managed surgically for PPU compared to females (8.1%). The mean age of the patients was 35.6years (SD14.92) with a peak incidence in the 3rd decade. Majority of the patients 66(75%) presented after 48 hours and 33(37.9%) had previous history of PUD. Most of the perforations were duodenal (68.2%) with the mean age of patients with duodenal and gastric ulcer perforations being 34.8 (SD14.8) years and 38.5 (SD15.5) years respectively. Among the 88 patients operated for PPU, 59.1% experienced post-operative complications while 10.2% (CI 4.8-18.5) died. Variables found significantly associated with complications by multivariate analysis were duration to surgery (0.027), cigarette smoking (<0.001), previous PUD history (<0.001) and hypoalbuminemia (<0.001). The ones predictive of mortality were duration to surgery (0.004), cigarette smoking (0.004), comorbid illness (0.005) and hypoalbuminemia (<0.001) Conclusion: Perforated duodenal ulcer is the commonest location of PPU in our setup and it commonly involves young male patients without prior history of PUD.