Brief Article
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World J Gastroenterol. Jan 21, 2013; 19(3): 347-354
Published online Jan 21, 2013. doi: 10.3748/wjg.v19.i3.347
Epidemiology of perforated peptic ulcer: Age- and gender-adjusted analysis of incidence and mortality
Kenneth Thorsen, Jon Arne Søreide, Jan Terje Kvaløy, Tom Glomsaker, Kjetil Søreide
Kenneth Thorsen, Jon Arne Søreide, Tom Glomsaker, Kjetil Søreide, Department of Surgery, Stavanger University Hospital, N-4068 Stavanger, Norway
Jan Terje Kvaløy, Department of Mathematics and Natural Science, University of Stavanger, 4036 Stavanger, Norway
Kenneth Thorsen, Jon Arne Søreide, Kjetil Søreide, Department of Surgical Science, University of Bergen, 5020 Bergen, Norway
Author contributions: Thorsen K contributed to conception, design, acquisition of data, analysis and interpretation of data, drafting the manuscript, evising it critically for important intellectual content and final approval of the version to be published; Søreide JA, Kvaløy JT and Glomsaker T contributed to analysis and interpretation of data, drafting the manuscript, revising it critically for important intellectual content and final approval of the version to be published; Søreide K contributed to conception and design, analysis and interpretation of data, drafting the manuscript, revising it critically for important intellectual content and final approval of the version to be published.
Correspondence to: Kjetil Søreide, MD, PhD, Professor of Surgery, Department of Surgery, Stavanger University Hospital, POB 8100, N-4068 Stavanger, Norway. ksoreide@mac.com
Telephone: +47-5151-8330 Fax: +47-5151-9919
Received: October 24, 2012
Revised: December 12, 2012
Accepted: December 20, 2012
Published online: January 21, 2013
Processing time: 89 Days and 14 Hours
Abstract

AIM: To investigate the epidemiological trends in incidence and mortality of perforated peptic ulcer (PPU) in a well-defined Norwegian population.

METHODS: A retrospective, population-based, single-center, consecutive cohort study of all patients diagnosed with benign perforated peptic ulcer. Included were both gastric and duodenal ulcer patients admitted to Stavanger University Hospital between January 2001 and December 2010. Ulcers with a malignant neoplasia diagnosis, verified by histology after biopsy or resection, were excluded. Patients were identified from the hospitals administrative electronic database using pertinent ICD-9 and ICD-10 codes (K25.1, K25.2, K25.5, K25.6, K26.1, K26.2, K26.5, K26.6). Additional searches using appropriate codes for relevant laparoscopic and open surgical procedures (e.g., JDA 60, JDA 61, JDH 70 and JDH 71) were performed to enable a complete identification of all patients. Patient demographics, presentation patterns and clinical data were retrieved from hospital records and surgical notes. Crude and adjusted incidence and mortality rates were estimated by using national population demographics data.

RESULTS: In the study period, a total of 172 patients with PPU were identified. The adjusted incidence rate for the overall 10-year period was 6.5 per 100 000 per year (95%CI: 5.6-7.6) and the adjusted mortality rate for the overall 10-year period was 1.1 per 100 000 per year (95%CI: 0.7-1.6). A non-significant decline in adjusted incidence rate from 9.7 to 5.6 occurred during the decade. The standardized mortality ratio for the whole study period was 5.7 (95%CI: 3.9-8.2), while the total 30-d mortality was 16.3%. No difference in incidence or mortality was found between genders. However, for patients ≥ 60 years, the incidence increased over 10-fold, and mortality more than 50-fold, compared to younger ages. The admission rates outside office hours were high with almost two out of three (63%) admissions seen at evening/night time shifts and/or during weekends. The observed seasonal variations in admissions were not statistically significant.

CONCLUSION: The adjusted incidence rate, seasonal distribution and mortality rate was stable. PPU frequently presents outside regular work-hours. Increase in incidence and mortality occurs with older age.

Keywords: Perforated peptic ulcer; Epidemiology; Incidence; Mortality; Seasonal variation