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BACKGROUND: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. METHOD: We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS: 1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS: This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.
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Introduction Emergencies such as appendicitis, peritonitis, road traffic accidents and gunshots require immediate surgical intervention. Patients are first resuscitated at the emergency department and then shifted to the casualty operation theater (COT). COT is a state-of-the-art operation theater that is open 24/7 and ready to deal with any surgical crisis. Once surgery is performed, the patients are admitted to the surgical ward for post-operative care. Jinnah Postgraduate Medical Centre (JPMC) is the largest tertiary care hospital in Karachi. There is very limited data on the cases that are dealt with on regular basis at the COT in JPMC. Here we break the mold and analyze the various aspects of surgical emergencies treated at the COT over the course of last six months. Objectives To evaluate the demographics and mortality rates of emergencies treated at the COT in the last six months. Methods This was a retrospective study, held for six months (July 1st 2019 to December 31st 2019). Data was obtained from the Records and Administration section, Surgical Unit IV (ward 21), Jinnah Postgraduate Medical Centre. Results Three hundred and fifty-five patients were inducted into the study, predominantly male. Majority (71.54%) of the referrals were made from within the city. The mean age of the patients was 48.57 ± 14.92 years. Appendicitis was the most common emergency treated at the COT. The overall mortality rate was 23.94%. Peritonitis and road traffic accidents contributed significantly to the mortality rate. Conclusion Surgical emergencies treated at the COT have a high mortality rate at one week. Prompt recognition, early referrals and intervention can help reduce mortality in the future.
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Introduction Organophosphate ingestion is the commonest cause of self-harm encountered at poison control centers in Pakistan. It usually affects a young populous. Organophosphates are found in various forms and formulations that are easily accessible to the general public. These compounds are extremely potent poisons causing rapid clinical deterioration with minimal ingestion or exposure. Signs and symptoms can range from mild or none to severe such as bradycardia, miosis, fasciculations, seizures and altered level of consciousness. Poisoning severity is measured using the Peradeniya Organophosphorus Poisoning (POP) scale. Mortality rates are relatively low for mild to moderate disease. Severe disease as calculated by the POP carries an exceptionally high mortality rate. The National Poisoning Control Centre (NPCC) at Jinnah Postgraduate Medical Centre, Karachi treats an extraordinary number of poisoning cases on a daily basis. Despite this data pertaining specifically to OP ingestion is nearly absent. There have been no studies analyzing the various aspects of organophosphate poisoning in the last 30 years to the best of our knowledge. Here, we look to rectify this. Aims To evaluate the demographics, severity scores and outcomes of organophosphate poisoning cases in the last year from the NPCC, Karachi. Methods This was a retrospective study. It was held from 1st January 2019 to 31st December 2019. All data was recorded from patients admitted to the NPCC with a proven diagnosis of organophosphate poisoning. Results Three thousand and three hundred patients were inducted into this study. Over 3/4th of the patients were teenagers or aged less than 30 years. Almost all referrals were made from within the city. Overall survival rate at 28 days was 89.45%. Most patients presented with mild to moderate disease as calculated by the POP; severe disease had a mortality rate of nearly 50%. Conclusion Organophosphates make up a significant portion of all cases of poisoning treated at the NPCC. The POP is an excellent tool to evaluate disease severity. Overall survival rates are good but mortality rate is high for severe disease even in young patients.