Association of onset-to-surgery time with morbidity and mortality among patients with perforated peptic ulcer: an observational cohort study

Abstract Background : Rapid surgery is recommended to improve outcomes after peptic ulcer perforation (PPU), but understanding of the optimal onset-to-surgery time for PPU is limited. The purpose of this study was to assess the optimal time of onset to surgery for PPU that improved patient outcomes. Methods : Data of eligible patients with PPU at three hospitals from 2019 to 2021 were retrospectively reviewed. Patients were categorized as a onset-to-surgery time of ≤ 12 h (early surgery [ES]) or > 12 h (late surgery [LS]). The primary outcome was 30-day sepsis morbidity. Secondary outcomes included 30-day postoperative morbidity and 30-day mortality. Patients’ characteristics and surgical outcomes were also compared. A P value of < 0.05 is considered as statistically significant. Results : Of 245 patients, 231 (94.3%; mean [SD] age, 62.6 [18.2] years; 153 [70.5%] male)were included in the final analysis. Among the remaining cases, 50.7% underwent ES and 49.3% underwent LS. LS was associated with increased sepsis morbidity within 30 days (OR adj 5.71, 95% CI 2.02-16.10, P = 0.001). In secondary analyses, LS was associated with an increased risk of postoperative morbidity (OR adj 1.93, 95% CI 1.06-3.53, P = 0.032). The 30-day mortality was 0.9% in the ES group and 4.7% in the LS group (OR adj 3.93, 95% CI 0.43-36.05, P = 0.227). In addition, the estimated blood loss during ES was significantly less than that during LS ( P = 0.004). The operative time and hospital stay were shorter in the ES group (both P <  0.005). Moreover, patients in the LS group were more likely to need for ICU admission (39.3% vs 22.7%, P = 0.008). Conclusions : This cohort study found evidence that more favorable outcomes were achieved when surgery was performed within 12 hours after the onset of severe abdominal pain among patients with PPU. These findings provide more clarity around the optimal time of onset to surgery for patients with PPU. However, more well powered researches are needed to confirm the findings.