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Delay in Source Control in Perforated Peptic Ulcer Leads to 6% Increased Risk of Death Per Hour: A Nationwide Cohort Study

Boyd-Carson, H.; Doleman, B.; Cromwell, D.; Lockwood, S.; Williams, J. P.; Tierney, G. M.; Lund, J. N.; Anderson, I. D.; for The National Emergency Laparotomy Audit Collaboration


H. Boyd-Carson

B. Doleman

D. Cromwell

S. Lockwood

J. P. Williams

G. M. Tierney

I. D. Anderson

for The National Emergency Laparotomy Audit Collaboration


© 2019, Société Internationale de Chirurgie. Background: Delay to theatre for patients with intra-abdominal sepsis is cited as a particular risk factor for death. Our aim was to evaluate the potential relationship between hourly delay from admission to surgery and post-operative mortality in patients with perforated peptic ulcer (PPU). Methods: All patients entered in the National Emergency Laparotomy Audit who had an emergency laparotomy for PPU within 24h of admission from December 2013 to November 2017 were included. Time to theatre from admission was modelled as a continuous variable in hours. Outcome was 90-day mortality. Logistic regression adjusting for confounding factors was performed. Results: 3809 patients were included, and 90-day mortality rate was 10.61%. Median time to theatre was 7.5h (IQR 5–11.6h). The odds of death increased with time to operation once adjustment for confounding variables was performed (per hour after admission adjusted OR 1.04 95% CI 1.02–1.07). In patients who were physiologically shocked (N = 334), there was an increase of 6% in risk-adjusted odds of mortality for every hour Em Lap was delayed after admission (OR 1.06 95% CI 1.01–1.11). Conclusion: Hourly delay to theatre in patients with PPU is independently associated with risk of death by 90days. Therefore, we suggest that surgical source control should occur as soon as possible after admission regardless of time of day.

Journal Article Type Article
Publication Date Oct 29, 2019
Journal World Journal of Surgery
Print ISSN 0364-2313
Electronic ISSN 1432-2323
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 44
Pages 869–875
APA6 Citation Boyd-Carson, H., Doleman, B., Cromwell, D., Lockwood, S., Williams, J. P., Tierney, G. M., …for The National Emergency Laparotomy Audit Collaboration, . (2019). Delay in Source Control in Perforated Peptic Ulcer Leads to 6% Increased Risk of Death Per Hour: A Nationwide Cohort Study. World Journal of Surgery, 44, 869–875.
Keywords Surgery
Publisher URL
Additional Information This is a post-peer-review, pre-copyedit version of an article published in World Journal of Surgery. The final authenticated version is available online at: