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Research topic on perforated pud predictors of outcome

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perforated peptic ulcer predictors outcomes WSES guideline risk score

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Research topic

“Predictors of postoperative morbidity and mortality among patients operated for perforated peptic ulcer disease: a prospective cohort study.”

Background

Perforated peptic ulcer disease is a surgical emergency with substantial risk of sepsis, postoperative complications, prolonged hospitalization, and death. Outcomes are influenced not only by the perforation itself but also by the patient’s physiological state, comorbidities, delay to treatment, and degree of peritoneal contamination.

Research question

Among patients undergoing surgery for perforated peptic ulcer, which preoperative and intraoperative factors predict poor postoperative outcome?

Primary outcome

  • 30-day mortality or in-hospital mortality

Secondary outcomes

  • Postoperative complications, especially sepsis, surgical-site infection, leak, respiratory complications, acute kidney injury, and reoperation
  • ICU admission
  • Length of hospital stay
  • Clavien-Dindo grade III-V complications

Candidate predictors

Patient factors
  • Age
  • Sex
  • Comorbidities: diabetes, chronic kidney disease, cardiac disease, chronic liver disease, malignancy
  • ASA physical-status class
  • Nutritional status, BMI, serum albumin
  • Smoking, alcohol use, NSAID or steroid use
Presentation and resuscitation factors
  • Duration of symptoms or delay to hospital presentation, for example >24 hours
  • Delay from admission to operation
  • Hypotension or shock at presentation
  • Heart rate, oxygen saturation, altered mental status
  • Sepsis or septic shock
  • Hemoglobin, white-cell count, creatinine, lactate, CRP, albumin
  • Acute kidney injury
Operative factors
  • Site of perforation: gastric versus duodenal
  • Perforation size, particularly >2 cm
  • Degree and nature of peritoneal contamination: purulent or fecal peritonitis
  • Surgical approach: open versus laparoscopic
  • Type of repair and need for definitive ulcer surgery
  • Operative duration
  • Intraoperative blood loss

Useful prognostic scores

  • Boey score: preoperative shock, serious medical illness, and perforation duration >24 hours. Risk rises markedly as the score increases.
  • PULP score: includes age, comorbidity, shock, renal impairment, steroid use, time from perforation, and ASA class.
  • ASA classification and Mannheim Peritonitis Index can also be assessed.
A recent systematic review and meta-analysis found that Boey and PULP scores remain useful prognostic tools, although their performance can vary between settings (Christanto & Adrianto, 2026, PMID 42031639). Recent observational evidence also consistently identifies older age, comorbidity, preoperative hypotension, and delayed presentation as predictors of adverse outcomes (Jigjiga cohort).

Suggested objectives

General objective
To determine predictors of poor postoperative outcomes in patients undergoing emergency surgery for perforated peptic ulcer disease.
Specific objectives
  1. To determine the frequency of postoperative complications and mortality.
  2. To identify demographic, clinical, laboratory, and operative variables associated with poor outcome.
  3. To assess whether delayed presentation and preoperative shock independently predict mortality.
  4. To evaluate the predictive accuracy of the Boey and/or PULP score in the local population.

Suggested methodology

  • Design: Prospective observational cohort study, or retrospective cohort if records are reliable.
  • Population: Adults undergoing operative management for radiologically or surgically confirmed perforated gastric or duodenal ulcer.
  • Analysis: Univariate analysis followed by multivariable logistic regression for mortality and major complications. Report adjusted odds ratios with 95% confidence intervals.
  • Main dependent variable: Composite poor outcome, defined as 30-day death and/or Clavien-Dindo grade III-V complication.

Shorter title alternatives

  1. Predictors of mortality following surgery for perforated peptic ulcer disease
  2. Factors associated with adverse postoperative outcomes in perforated peptic ulcer
  3. Validation of Boey and PULP scores in perforated peptic ulcer disease
  4. Effect of delayed presentation on outcomes of perforated peptic ulcer surgery
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