Emergency Management of Perforated Gastro-Duodenal Ulcers: Surgical Strategies, Outcomes, and Prognostic Determinants in a Tertiary Eastern European Center

<i>Background and Objectives</i>: Perforated gastro-duodenal ulcers (PGDUs) are life-threatening surgical emergencies with high morbidity and mortality. This study aimed to evaluate surgical strategies, outcomes, and prognostic factors in patients treated for PGDUs in a tertiary Eastern European center. <i>Materials and Methods</i>: We conducted a retrospective cross-sectional analysis of 156 patients admitted with PGDUs between 2020 and 2024. Data on demographics, risk factors, ulcer location, type of surgical approach, operative details, hospital stay, and mortality were collected. Statistical analysis included chi-square, Mann-Whitney U, and multivariate logistic regression. <i>Results</i>: The mean age was 57.6 ± 15.9 years (range 18-91), with men accounting for 64.7% of cases. Alcohol use was significantly associated with male sex (<i>p</i> = 0.012), while NSAID use was equally distributed. Open surgery was the mainstay of treatment (85.9%), with laparoscopy performed in 12.8% and conversion in 1.9%. Median hospital stay was shorter after laparoscopic repair (7.5 vs. 9 days, <i>p</i> = 0.039. On multivariate analysis, both age and comorbidity burden were independent predictors of mortality (<i>p</i> < 0.01). <i>Conclusions</i>: PGDU management in Eastern Europe remains dominated by open surgery. Laparoscopy, though underutilized, is associated with shorter recovery. Age is the strongest determinant of mortality, highlighting the need for early risk stratification, wider adoption of minimally invasive techniques, and preventive measures targeting modifiable risk factors.