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Abstract
Introduction: Perforated peptic ulcer (PPU) disease is a common indication of emergency surgery, accounting for 2–10% of all peptic ulcer cases. The American Society of Anaesthesiologists (ASA), Boey, and the peptic ulcer perforation (PULP) score are the most regularly utilised scoring systems to risk stratify patients who are likely to develop complications and to focus resources on high-risk patients.
Objective: To assess the accuracy of PULP score, Boey, and ASA in predicting 30-day perforated peptic ulcer morbidity.
Methodology: A retrospective cross-sectional study was done in a tertiary care hospital in Nepal with review of two-year (2018 April 14 to 2020 May 12) data of all (census) perforated duodenal ulcer (PDU) patients (74 cases). Data were collected after taking ethical clearance, which included demographic, clinical history, laboratory investigation, operative finding, and post-operative morbidity and mortality. For inferential statistics, Chi-square, and Independent t-test were applied to find significant association between various cut off values and numerical values of score and other selected variable. A receiver operating characteristic (ROC) curve analysis was used to determine the scale's predictive accuracy for each outcome.
Result: Male predominance (5.7:1) was present (Mean age 46.49 years). Post PDU repair morbidity and mortality were 37.83% and 4.05% respectively. Higher ASA (>3), Boey (>1), PULP (>6), raised creatinine level, and preoperative comorbidity (n = 15) were significantly associated with morbidity. Boey displayed largest (84%) area under the curve (AUC) in predicting morbidity.
Conclusion: Boey and PULP score can be utilised as precise predictor of morbidity.
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