S3072 From Perforation to Mortality: National Predictors of In-Hospital Death in Perforated Peptic Ulcer Disease

Introduction: Peptic ulcer disease (PUD), complicated by perforation, is a serious complication requiring emergent intervention with a significant risk of in-hospital mortality. Despite medical and surgical advancements, outcomes remain dismal for many patients. In this study, we use a large nationally representative dataset to identify clinical predictors and evaluate temporal trends in in-hospital mortality among patients admitted with PUD. Methods: We queried the National Inpatient Sample database from 2016–2021 for hospitalizations with perforated PUD (age ≥18 years) using validated International Classification of Diseases-10-CM codes. Demographics, comorbidities, in-hospital mortality, and temporal mortality trends were assessed. We utilized a multivariable logistic regression model to identify independent predictors of mortality in the perforated PUD subgroup and report adjusted odds ratio (aOR) with a 95% confidence interval (95% CI). Mortality trends were assessed using the Cochran-Armitage test for trend, while comorbidities were compared using the Pearson Chi-Square test. Sampling weights were applied to generate national estimates. Results: Among 2,561,379 weighted hospitalizations for PUD, 207,970 (8.1%) were noted to have perforation. Overall, in-hospital mortality in the perforated cohort was higher than in the non-perforated cohort (7.2% vs 3.3%, P < 0.001). In-hospital mortality in perforated PUD showed an upward trend over the years, increasing from 6.9% in 2016 to 8.0% in 2021 (P < 0.001). On multivariable analysis, independent predictors of mortality included age 45-64 y (aOR 2.78, 95% CI 2.24-3.46) and ≥65 y (aOR 5.41, 95% CI 4.34-6.73) compared to 18–44 y (both P < 0.001). Female sex was associated with decreased odds of death (aOR 0.90, 95% CI 0.83-0.98, P = 0.013). Comorbidities associated with increased mortality included heart failure (aOR 1.75, 95% CI 1.58-1.94), chronic kidney disease (aOR 1.40, 95% CI 1.27-1.55), COPD (aOR 1.52, 95% CI 1.38-1.69), cirrhosis/fibrosis (aOR 1.96, 95% CI 1.65-2.33), and COVID-19 (aOR 4.35, 95% CI 3.46-5.47), all with P < 0.001. Conclusion: In-hospital mortality remains high in perforated PUD and appears to be gradually increasing in the past few years despite improvements in supportive care. Advancing age and comorbid multi-organ conditions significantly increase the odds of mortality. These findings underscore the importance of early risk stratification and targeted management strategies for high-risk patients, particularly in light of the increasing national mortality trends.