Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality. A nationwide prospective cohort study.

Sergej Zogovic; Bojesen Anders; S Andos; Frank Viborg Mortensen

doi:10.1016/j.ijsu.2019.10.017

Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality. A nationwide prospective cohort study.

Sergej Zogovic, Bojesen Anders, S Andos, Frank Viborg Mortensen

Department of Clinical Medicine - The Department of Surgical Gastroenterology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

12 Citations (Scopus)

Abstract

Background: Laparoscopic surgery has become increasingly popular in treating perforated peptic ulcer (PPU). However, currently it is not recognized as a prognostic factor for mortality within this group of patients. The aim of this study was to investigate whether laparoscopic surgery was an independent mortality risk factor in patients treated surgically for perforated peptic ulcer. Materials and methods: This was a Danish nationwide cohort study based on prospectively collected data of 1008 patients treated surgically for PPU between September 2011 and December 2015. A propensity score matching analysis, considering most of the known prognostic factors for mortality and baseline characteristics, was used to adjust mortality estimates in patients treated with open and laparoscopic surgery. The primary outcome was postoperative 30-day mortality. Results: The study population comprised 1008 patients; 507 were treated laparoscopically and 501 by open surgery. There was significantly higher mean age, and higher ASA scores, as well as other mortality risk factors in the open surgery group. The unadjusted 30-day mortality was significantly lower in patients undergoing laparoscopic surgery compared to open surgery (HR = 0.48, 95% CI: 0.36–0.65). After matching and weighting controls, the adjusted difference in mortality was reduced and was not significant (HR = 0.82, 95% CI: 0.59–1.15). The 30-day mortality was 13.1% for laparoscopy and 14.7% for the matched controls in the open surgery group. Conclusions: Compared to open surgery, laparoscopic surgery in patients with PPU does not reduce short term mortality. More well powered randomized clinical trials are needed to investigate the role of laparoscopic surgery in treatment of patients with PPU.

Original language	English
Journal	International Journal of Surgery
Volume	72
Pages (from-to)	47-54
Number of pages	8
ISSN	1743-9191
DOIs	https://doi.org/10.1016/j.ijsu.2019.10.017
Publication status	Published - Dec 2019

Keywords

Laparoscopic surgery
Mortality
Perforated peptic ulcer
Risk factors

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@article{2077f8f447784865a636a68534ce4b7c,

title = "Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality. A nationwide prospective cohort study.",

abstract = "Background: Laparoscopic surgery has become increasingly popular in treating perforated peptic ulcer (PPU). However, currently it is not recognized as a prognostic factor for mortality within this group of patients. The aim of this study was to investigate whether laparoscopic surgery was an independent mortality risk factor in patients treated surgically for perforated peptic ulcer. Materials and methods: This was a Danish nationwide cohort study based on prospectively collected data of 1008 patients treated surgically for PPU between September 2011 and December 2015. A propensity score matching analysis, considering most of the known prognostic factors for mortality and baseline characteristics, was used to adjust mortality estimates in patients treated with open and laparoscopic surgery. The primary outcome was postoperative 30-day mortality. Results: The study population comprised 1008 patients; 507 were treated laparoscopically and 501 by open surgery. There was significantly higher mean age, and higher ASA scores, as well as other mortality risk factors in the open surgery group. The unadjusted 30-day mortality was significantly lower in patients undergoing laparoscopic surgery compared to open surgery (HR = 0.48, 95% CI: 0.36–0.65). After matching and weighting controls, the adjusted difference in mortality was reduced and was not significant (HR = 0.82, 95% CI: 0.59–1.15). The 30-day mortality was 13.1% for laparoscopy and 14.7% for the matched controls in the open surgery group. Conclusions: Compared to open surgery, laparoscopic surgery in patients with PPU does not reduce short term mortality. More well powered randomized clinical trials are needed to investigate the role of laparoscopic surgery in treatment of patients with PPU.",

keywords = "Laparoscopic surgery, Mortality, Perforated peptic ulcer, Risk factors",

author = "Sergej Zogovic and Bojesen Anders and S Andos and Mortensen, {Frank Viborg}",

year = "2019",

month = dec,

doi = "10.1016/j.ijsu.2019.10.017",

language = "English",

volume = "72",

pages = "47--54",

journal = "International Journal of Surgery",

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Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality. A nationwide prospective cohort study. / Zogovic, Sergej; Anders, Bojesen; Andos, S et al.
In: International Journal of Surgery, Vol. 72, 12.2019, p. 47-54.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality. A nationwide prospective cohort study.

AU - Zogovic, Sergej

AU - Anders, Bojesen

AU - Andos, S

AU - Mortensen, Frank Viborg

PY - 2019/12

Y1 - 2019/12

N2 - Background: Laparoscopic surgery has become increasingly popular in treating perforated peptic ulcer (PPU). However, currently it is not recognized as a prognostic factor for mortality within this group of patients. The aim of this study was to investigate whether laparoscopic surgery was an independent mortality risk factor in patients treated surgically for perforated peptic ulcer. Materials and methods: This was a Danish nationwide cohort study based on prospectively collected data of 1008 patients treated surgically for PPU between September 2011 and December 2015. A propensity score matching analysis, considering most of the known prognostic factors for mortality and baseline characteristics, was used to adjust mortality estimates in patients treated with open and laparoscopic surgery. The primary outcome was postoperative 30-day mortality. Results: The study population comprised 1008 patients; 507 were treated laparoscopically and 501 by open surgery. There was significantly higher mean age, and higher ASA scores, as well as other mortality risk factors in the open surgery group. The unadjusted 30-day mortality was significantly lower in patients undergoing laparoscopic surgery compared to open surgery (HR = 0.48, 95% CI: 0.36–0.65). After matching and weighting controls, the adjusted difference in mortality was reduced and was not significant (HR = 0.82, 95% CI: 0.59–1.15). The 30-day mortality was 13.1% for laparoscopy and 14.7% for the matched controls in the open surgery group. Conclusions: Compared to open surgery, laparoscopic surgery in patients with PPU does not reduce short term mortality. More well powered randomized clinical trials are needed to investigate the role of laparoscopic surgery in treatment of patients with PPU.

AB - Background: Laparoscopic surgery has become increasingly popular in treating perforated peptic ulcer (PPU). However, currently it is not recognized as a prognostic factor for mortality within this group of patients. The aim of this study was to investigate whether laparoscopic surgery was an independent mortality risk factor in patients treated surgically for perforated peptic ulcer. Materials and methods: This was a Danish nationwide cohort study based on prospectively collected data of 1008 patients treated surgically for PPU between September 2011 and December 2015. A propensity score matching analysis, considering most of the known prognostic factors for mortality and baseline characteristics, was used to adjust mortality estimates in patients treated with open and laparoscopic surgery. The primary outcome was postoperative 30-day mortality. Results: The study population comprised 1008 patients; 507 were treated laparoscopically and 501 by open surgery. There was significantly higher mean age, and higher ASA scores, as well as other mortality risk factors in the open surgery group. The unadjusted 30-day mortality was significantly lower in patients undergoing laparoscopic surgery compared to open surgery (HR = 0.48, 95% CI: 0.36–0.65). After matching and weighting controls, the adjusted difference in mortality was reduced and was not significant (HR = 0.82, 95% CI: 0.59–1.15). The 30-day mortality was 13.1% for laparoscopy and 14.7% for the matched controls in the open surgery group. Conclusions: Compared to open surgery, laparoscopic surgery in patients with PPU does not reduce short term mortality. More well powered randomized clinical trials are needed to investigate the role of laparoscopic surgery in treatment of patients with PPU.

KW - Laparoscopic surgery

KW - Mortality

KW - Perforated peptic ulcer

KW - Risk factors

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U2 - 10.1016/j.ijsu.2019.10.017

DO - 10.1016/j.ijsu.2019.10.017

M3 - Journal article

C2 - 31639454

SN - 1743-9191

VL - 72

SP - 47

EP - 54

JO - International Journal of Surgery

JF - International Journal of Surgery

ER -

Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality. A nationwide prospective cohort study.

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Keywords

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