30-days mortality in patients with perforated peptic ulcer: A national audit

Anne Nakano^1,4, Jørgen Bendix², Sven Adamsen³, Daniel Buck⁴, Jan Mainz⁵, Paul Bartels¹, Bente Nørgård^4,6

¹The Danish National Indicator Project, Regionshuset Aarhus, Aarhus, Denmark; ²Department of Gastrointestinal Surgery L, Aarhus University Hospital, Denmark; ³Digestive Disease Center, Section for Gastrointestinal Surgery, Copenhagen, Denmark; University Hospital Herlev, Denmark; ⁴Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; ⁵Department of Psychiatry Region North, Denmark and Institute of Public Health, University of Southern Denmark, Odense, Denmark; ⁶Center for National Clinical Databases, South, Odense University Hospital, and Epidemiology, Institute of Public Health, University of Southern Denmark, Odense, Denmark

Background: In 2005, The Danish National Indicator Project (DNIP) reported findings on patients hospitalized with perforated ulcer. The indicator “30-days mortality” showed major discrepancy between the observed mortality of 28% and the chosen standard (10%).

Rationale: An audit committee was appointed to examine quality problems linked to the high mortality. The purpose was to (i) examine patient characteristics, (ii) evaluate the appropriateness of the standard, and (iii) audit all cases of deaths within 30 days after surgery.

Methods: Four hundred and twelve consecutive patients were included and used for the analyses of patient characteristics. The evaluation of the standard was based on a literature review, and a structured audit was performed according to the 115 deaths that occurred.

Results: The mean age was 69.1 years, 42.0% had one co-morbid disease and 17.7% had two co-morbid diseases. 45.9% had an American Association of Anaesthetists score of 3–4. We found no results on mortality in studies similar to ours. The audit process indicated that the postoperative observation of patients was insufficient.

Discussion: As a result of this study, the standard for mortality was increased to 20%, and the new indicators for postoperative monitoring were developed. The DNIP continues to evaluate if these initiatives will improve the results on mortality.

Keywords: mortality, perforated peptic ulcer, ulcer, audit