Original Article

Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation

  1. M. H. Møller1,*,
  2. S. Adamsen2,
  3. R. W. Thomsen3,
  4. A. M. Møller1,
  5. on behalf of the Peptic Ulcer Perforation (PULP) trial group

Article first published online: 25 MAR 2011

DOI: 10.1002/bjs.7429

Issue

British Journal of Surgery

British Journal of Surgery

Volume 98, Issue 6, pages 802–810, June 2011

Additional Information

How to Cite

Møller, M. H., Adamsen, S., Thomsen, R. W., Møller, A. M. and on behalf of the Peptic Ulcer Perforation (PULP) trial group (2011), Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. British Journal of Surgery, 98: 802–810. doi: 10.1002/bjs.7429

Author Information

  1. 1

    Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev, Herlev, Denmark

  2. 2

    Department of Gastrointestinal Surgery, Copenhagen University Hospital Herlev, Herlev, Denmark

  3. 3

    Department of Clinical Epidemiology, Clinical Institute, Aarhus University Hospital, Aarhus, Denmark

*Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK—2730 Herlev, Denmark

Publication History

  1. Issue published online: 26 APR 2011
  2. Article first published online: 25 MAR 2011
  3. Manuscript Accepted: 16 DEC 2010

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Protocol improves survival

Abstract

Background:

Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU.

Methods:

This was an externally controlled multicentre trial set in seven gastrointestinal departments in Denmark. Consecutive patients who underwent surgery for gastric or duodenal PPU between 1 January 2008 and 31 December 2009 were treated according to a multimodal and multidisciplinary evidence-based perioperative care protocol. The 30-day mortality rate in this group was compared with rates in historical and concurrent national controls.

Results:

The 30-day mortality rate following PPU was 17·1 per cent in the intervention group, compared with 27·0 per cent in the three control groups (P = 0·005). This corresponded to a relative risk of 0·63 (95 per cent confidence interval 0·41 to 0·97), a relative risk reduction of 37 (5 to 58) per cent and a number needed to treat of 10 (6 to 38).

Conclusion:

The 30-day mortality rate in patients with PPU was reduced by more than one-third after the implementation of a multimodal and multidisciplinary perioperative care protocol, compared with conventional treatment. Registration number: NCT00624169 (http://www.clinicaltrials.gov). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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