Predictors of postoperative complications after surgery for perforated peptic ulcer - a prospective study from a tertiary center of Nepal

Sep 29, 2026

Prospective observational research from a tertiary center in Nepal evaluates factors linked to postoperative complications and in-hospital mortality in adults undergoing emergency laparotomy with omental patch repair for perforated peptic ulcer. Demographic, clinical, and perioperative variables were collected using a structured proforma, and associations were tested with logistic regression expressed as odds ratios with 95% confidence intervals. Age ≥60 years and preoperative shock showed significantly higher odds of complications. Findings suggest high-risk identification, with recommendations for multicenter validation.

LanguageEnglish

CategoryHealthcare

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Pages5

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Cross-sectional Study Predictors of postoperative complications after surgery for perforated peptic ulcer: a prospective study from a tertiary center of Nepal Bibhav Hari Koirala, MBBS, MSa , Pawan Sapkota Upadhya, MBBS, MSb , Prajjwol Luitel, MBBSc ,*, Sachin Upreti, MBBSc , Anjana Nuri Pokharel, MBBS, MDd , Aditya Prakash Yadhav, MBBS, MSa , K. N. Singh, MBBS, MSa Introduction: Peptic ulcer disease (PUD) and its consequences are prevalent in developing countries. This study aimed to identify predictors of postoperative complications and mortality among patients undergoing emergency surgery for perforated PUD in a tertiary care center of Nepal. Methods: A prospective cohort study of consecutive adults undergoing emergency laparotomy with omental patch repair for perforated PUD was performed. Demographics, clinical, and perioperative data were recorded using a structured proforma. Predictors of complications and in-hospital mortality were assessed with logistic regression; results are reported as odds ratios (ORs) with 95% confidence intervals (CIs) . Results: Among the 85 patients (mean age 42 ± 15.4 years; 88% males), complications occurred in 42.4% and mortality in 5.9% . Age ≥60 years (adjusted OR 30.4, 95% CI 2.7–347.7; P = 0.006) and preoperative shock (adjusted OR 13.9, 95% CI 2–92.9; P = 0.006) were associated with higher odds of complications. Conclusion: Age ≥60 years and preoperative shock may help identify patients at higher risk of postoperative complications after perforated PUD repair. Given the small sample size and event constraints, these results are exploratory; multicenter validation with adequate power is warranted. Keywords: emergency surgery, mortality, peptic ulcer perforation, postoperative complications, prognosis, risk factors Introduction Although the prevalence of peptic ulcer disease (PUD) has decreased in developed countries, PUD remains a major health concern in developing countries [1] . The Global Burden of Disease 2019 study reported that marked geographic heterogeneity exists, with South Asian countries having the highest agestandardized prevalence of PUD − 156.6 per 100 000 population [95% confidence interval (CI): 130.58–187.05] − while the highincome countries showed the lowest age-standardized mortality rates[2] . PUD has a lifetime risk of 5–10% and an annual aDepartment of General Surgery, National Medical College and Teaching Hospital, Birgunj, Nepal, bDepartment of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, cMaharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal and dDepartment of Pathology, National Medical College and Teaching Hospital, Birgunj, Nepal Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, [Nepal. E-mail: drprajjwolluitel@gmail.com](Nepal. E-mail: drprajjwolluitel@gmail.com) (P. Luitel). Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Annals of Medicine & Surgery (2026) 88:228–232 Received 3 July 2025; Accepted 30 November 2025 Published online 11 December 2025 [http://dx.doi.org/10.1097/MS9.0000000000004564](http://dx.doi.org/10.1097/MS9.0000000000004564) HIGHLIGHTS ● Identification of predictors for postoperative complications is crucial in perforated peptic ulcer. ● Age > 60 years and preoperative shock independently predicted postoperative complications and mortality. ● The overall complication rate was 42% and the mortality was 6% . in

FAQs

What was the study designed to determine for patients with perforated peptic ulcer?

To identify predictors of postoperative complications and in-hospital mortality among patients undergoing emergency surgery for perforated peptic ulcer in a tertiary care center in Nepal.

How were outcomes and predictors analyzed in the study?

Demographic, clinical, and perioperative data were collected with a structured proforma, and logistic regression assessed associations with complications and mortality, reported as odds ratios with 95% confidence intervals.

Which factors were associated with higher odds of postoperative complications?

Age ≥60 years and preoperative shock were associated with higher odds of postoperative complications, with statistically significant adjusted odds ratios.

Sep 29, 2026

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