Impact of Cirrhosis in Patients with Perforated Peptic Ulcer Disease: A Propensity Score Matching Analysis
*Amir Ebadinejad2, *Juan P. Cobar2, *Ya-Huei Li1, *Maya Petashnick4, Oscar K. Serrano3
1. Department of Research Administration, Hartford HealthCare, Hartford, CT, United States. 2. Department of Surgery, Hartford Hospital, Hartford, CT, United States. 3. Transplant & Comprehensive Liver Center, Hartford Hospital, Hartford, CT, United States. 4. Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, United States.
Introduction:
Although the incidence of perforated peptic ulcer disease (PPUD) has diminished worldwide, it remains a critical surgical emergency with potentially life-threatening consequences. It is uniquely precarious in the cirrhotic patient. We sought to assess the impact of cirrhosis on outcomes following presentation with PPUD.
Methods:
A retrospective analysis of data from the 2012-2014 National Inpatient Sample was conducted to identify individuals with PPUD, utilizing the International Classification of Diseases, 9th Revision (ICD-9) codes. The identified population was categorized into two groups: patients with and without cirrhosis. Propensity score matching (PSM) was utilized to match individuals in the non-cirrhotic group with those in the cirrhotic group, utilizing a 5:1 ratio based on 30 clinical parameters including patient characteristics, hospital characteristics, and baseline comorbidities. Outcome measures included mortality rates, length of hospital stay (LOS), healthcare costs, and incidence of complications.
Results:
Among the 5,742 patients diagnosed with PPUD during the study period, 151 had cirrhosis and were compared with 755 matched controls. Compared to non-cirrhotic patients, cirrhotic individuals exhibited a higher prevalence of coagulopathy (33.1% vs. 5.7%; p <0.001), a greater number of chronic conditions (median [M]: 7, interquartile range [IQR]: 5-9 vs. M: 5, IQR: 3-8, p <0.001), and more severe illness with extreme functional loss (56.3% vs. 24.9%; p <0.001) upon admission. Hospital mortality rates were significantly elevated among cirrhotic patients (19.2% vs. 4.6%, p <0.001). Cirrhotic patients experienced a higher incidence of severe complications (p?0.017), including respiratory failure (41.7% vs. 18.0%), sepsis (31.1% vs. 11.5%), shock (23.8% vs. 8.6%), and cardiac arrest (2.6% vs. 0.4%). Cirrhotic patients required a greater number of surgical and non-surgical procedures (M: 4, IQR: 2-7 vs. M: 2, IQR: 1-4; p <0.001) and had a longer LOS (M: 9, IQR: 6-15 vs. M: 7, IQR: 5-11 days; p <0.001). The hospitalization costs for cirrhotic and non-cirrhotic patients were ,813 (IQR: 58,425-176,921) and ,769 (IQR: 39,590-111,742), respectively (p <0.001). Non-cirrhotic patients exhibited a higher proportion of private (21.5% vs. 18.1%) and Medicare (44.4% vs. 40.3%) insurance coverage, whereas cirrhotic patients were more reliant on Medicaid (24.2% vs. 13.7%;p=0.026).
Conclusion
Cirrhosis significantly impacts the outcomes of patients presenting with PPUD exhibiting higher mortality rates, more severe complications, longer hospital stays, and increased healthcare costs. These findings emphasize the need for tailored preventive strategies to mitigate the risks of PPUD in the cirrhotic population using multidisciplinary efforts.
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