Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years

Table 1 Trends in patient characteristics according to decade of treatment, n (%)

n = 209	1978–1987 (n = 38)	1988–1997 (n = 64)	1998–2007 (n = 62)	2008-2017 (n = 45)	P value
Sex
Women	14 (36.8)	26 (40.6)	31 (50.0)	25 (55.6)	0.049a
Men	24 (63.2)	38 (59.4)	31 (50.0)	20 (44.4)
Incidence (No./100000)
Women	3.3 (1.8 to 5.5)	6.0 (3.9 to 8.8)	7.0 (4.8 to 9.9)	5.3 (3.4 to 7.8)	0.14b
Men	5.5 (3.6 to 8.3)	8.7 (6.2 to 12.0)	7.0 (4.8 to 10.0)	4.2 (2.6 to 6.5)	0.32b
Age, mean ± SD, years	62 ± 17	64 ± 16	67 ± 16	69 ± 17	0.018c
Hours from symptom debut until admission, mean ± SD)	7 ± 9	8 ± 12	16 ± 29	13 ± 14	0.019c
ASA class
II	30 (78.9)	46 (71.9)	33 (53.2)	24 (53.3)	0.001d
III	6 (15.8)	13 (20.3)	19 (30.6)	11 (24.2)
IV	2 (5.3)	5 (7.8)	10 (16.1)	9 (20.0)
V	0	0	0	1 (2.2)
Ulcer localisation
Gastric	25 (65.8)	27 (42.2)	26 (41.9)	19 (42.2)	0.059a
Duodenal	13 (34.2)	37 (57.8)	36 (58.1)	26 (57.8)
Past ulcer history	5 (13.2)	25 (39.1)	16 (26.2)	0	0.022a
Smoker at present	19 (57.6)	40 (64.5)	27 (49.1)	26 (59.1)	0.89a
NSAID use	4 (10.5)	11 (17.2)	19 (31.1)	8 (17.8)	0.18a
Steroid use	2 (5.3)	2 (3.1)	7 (11.5)	3 (6.7)	0.42a
Salicylate use	2 (5.3)	4 (6.3)	10 (16.4)	8 (17.8)	0.025a
Charlson Comorbidity index
0	26 (68.4)	37 (57.8)	29 (46.8)	18 (40.0)	0.003d
1	5 (13.2)	22 (34.4)	24 (38.7)	13 (28.9)
2+	7 (18.4)	5 (7.8)	9 (14.5)	14 (31.1)

^aCochran-Armitage exact trend test.

^bPoisson regression with calendar year as covariate.

^cJonckheere-Terpstra exact test.

^dOrdered logistic regression analysis. SD: Standard deviation; ASA: American Society of Anesthesiologists; NSAID: Non-steroidal anti-inflammatory drugs.

Table 2 Factors associated with peptic ulcer perforation incidence rate ratios from 1978 to 2017. Data are presented as adjusted incidence rate ratios from Poisson regression with calendar year and age as covariates

	Male	P value	Female	P value
	IRR (CI)		IRR (CI)
Total peptic ulcer perforation
Calendar year	0.986 (0.970 to 1.001)	0.074	1.005 (0.988 to 1.023)	0.55
Age (per 5 yr)	1.040 (1.029 to 1.051)	< 0.001	1.060 (1.047 to 1.073)	< 0.001
Gastric ulcer perforation
Calendar year	0.979 (0.956 to 1.001)	0.063	0.998 (0.973 to 1.024)	0.90
Age (per 5 yr)	1.037 (1.022 to 1.053)	< 0.001	1.056 (1.038 to 1.075)	< 0.001
Duodenal ulcer perforation
Calendar year	0.992 (0.971 to 1.014)	0.49	1.011 (0.988 to 1.035)	0.36
Age (per 5 yr)	1.043 (1.028 to 1.058)	< 0.001	1.063 (1.045 to 1.080)	< 0.001

IRR: Incidence rate ratio; CI: Confidence interval.

Table 3 Trends in treatment and outcome according to decade of treatment, n (%)

n = 209	1978–1987 (n = 38)	1988–1997 (n = 64)	1998–2007 (n = 62)	2008-2017 (n = 45)	P value
Treatment
Simple closure with orwithout omentopexy	37 (97)	64 (100)	62 (100)	38 (84)
Gastric resection	1 (3)	0	0	4 (9)
No operation	0	0	0	3 (7)
Hours from admission to operation, mean ± SD	7 ± 9	8 ± 12	16 ± 29	13 ± 14	0.019a
Duration of operation, mean ± SD, min	72 ± 29	78 ± 35	61 ± 24	78 ± 40	0.15a
Re-operation	1 (3)	4 (6)	6 (10)	4 (9)	0.18b
Clavien-Dindo classification of complications
0	28 (74)	45 (70)	38 (61)	17 (38)	0.001c
1-2	6 (16)	8 (13)	9 (15)	13 (29)
3	1 (3)	1 (29)	4 (7)	4 (9)
4	0	4 (6)	3 (5)	3 (7)
5	3 (8)	6 (9)	8 (13)	8 (18)
100-day mortality	7 (18)	11 (17)	16 (26)	9 (20)	0.56b
Estimated 10-yr relative survival in patients surviving 100 d, (95%CI)	97 (70-114)	71 (52-87)	86 (64-103)	86 (51-108)	0.44d

^aJonckheere-Terpstra exact test.

^bCochran-Armitage exact trend test.

^cOrdered logistic regression analysis.

^dRelative survival analysis with calendar period as covariate. SD: Standard deviation; CI: Confidence interval.