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PTH-154 Changes in incidence and management of upper gi perforation over 14 years
  1. R Mclean,
  2. M Jones,
  3. D Fung,
  4. S Dixon,
  5. I McCallum
  1. General Surgery, Health Education North East, Newcastle, UK

Abstract

Introduction Procedures and admissions for upper GI perforation are common in acute general surgical practice. This study aimed to describe changes in incidence and outcomes of such patients over the last 14 years.

Method Trust information departments at Newcastle upon Tyne and Gateshead Health foundation trusts were contacted to request data for all emergency admissions under a general surgeon from 2000–2014 after necessary approvals. Cases were identified using ICD-10 codes: K25, K26, K27, and K28, with subdivisions 0.1, 0.2, 0.6, and 0.7. Data on demographics, co-morbidities, interventions and outcomes were also collected and analysed.

Results Upper gastrointestinal perforation (gastric and duodenal) accounted for 310/80,814 admissions (0.38%). The mean age was 56.9 years (95% CI: 54.9 to 58.9 years) and 62.6% of patients were male. The overall mean LOS was 17.9 days (95% CI: 14.7 to 21.2 days). 68 patients were managed conservatively (mean LOS 21.0 days), 227 patients were managed by open repair (LOS 17.7 days) and 15 by laparoscopic repair (LOS 6.6 days). There were 50 inpatient deaths (16.1%), 37/225 (16.4%) following an open repair, and 13/68 (19.1%) with conservative management. A laparoscopic approach was used in 9.6% of perforation repairs in the 2005–09 period and 8.1% in 2010–14 with no inpatient mortality. Operative management occurred in 81.3% (74/91) in 2000–04, 83.2% (94/113) in 2005–09, and 69.8% (74/106) in 2010–14. The inpatient mortality rate from UGI perforation has fallen from 28.6% to 15.9% and 5.7% over the respective time periods.

Conclusion Mortality from upper GI perforation has fallen significantly over the last 14 years. There is a trend towards increased conservative management although this is unlikely to account for all improvements and optimisation of ‘adjuvant’ medical therapy may be important. Laparoscopic repair has impressive results though case selection may be an important factor.

Disclosure of interest None Declared.

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