Assessment of the condition severity and prediction of postoperative complications in elderly and senile patients with perforated gastric and duodenal ulcer

Abstract

Aim. To assess the condition severity and predict postoperative complications and mortality in elderly and senile patients with perforated gastric and duodenal ulcer using the P-POSSUM score. Materials and methods. To conduct a scientific study, 80 (100.0 %) cases of treatment for patients aged 60 to 89 years with a diagnosis of gastric or duodenal ulcer perforation were analyzed. At the stage of hospitalization, the general condition was assessed using the variables of the P-POSSUM score. All patients underwent emergency surgery. Results. The obtained sum of points was compared with postoperative complications and mortality. We defined the discrimination point as >43 points for postoperative complications and >48 points for mortality. Based on the result, the patients were divided into group A with a sum of points up to 43 inclusive – 39 patients (48.8 %), and with a greater number of points – 41 patients (51.2 %) – group B. Evaluation of the detected complications in the postoperative period and comparison with the sum of points significantly confirmed an increase in their frequency in group B (sum of points >43) as compared to group A (sum of points ≤43) – p = 0.0018, U = 474.0. To compare the mortality rate, all the patients were divided into group C – 48 (60.0 %) patients with a sum of points ≤48, and group D – 32 patients (40.0 %) with a sum of points ≥49. In the group of patients with a total score >48 (group D), the mortality rate was significantly increased compared to group C with a score ≤48, p = 0.0002, U = 384.0. Conclusions. Our study has led to the following conclusions: the P-POSSUM score use in elderly and senile patients with perforated gastric and duodenal ulcers significantly confirms the increase in the frequency of postoperative complications, in group A – 6 (15.4 %) patients, while in group B – 23 (56.1 %), p = 0.0018, U = 474.0 and increased mortality, in group C – 6.3 %, in group D – 56.3 %, p = 0.0002, U = 384.0; the P-POSSUM score provides reliable prediction an increase in the risk of postoperative complications and mortality. This, in turn, makes it possible to predict and change treatment approaches and improve the quality of emergency surgical care for elderly and senile patients.

Keywords

• peptic ulcer
• peritonitis
• advanced age
• emergency surgery