S3071 Clinical and Economic Impact of Perforation in Peptic Ulcer Disease: A Propensity Score Matched Analysis of National Inpatient Data From the United States

Introduction: Perforation is a severe complication of peptic ulcer disease (PUD) that significantly increases the risk of morbidity, mortality, and healthcare burden. However, confounding due to differing baseline characteristics often limits comparisons between patients with perforated and non-perforated PUD. In this study, we employ propensity score matching (PSM) to assess the independent impact of perforation on clinical outcomes and resource utilization in hospitalized patients with PUD. Methods: We utilized 6 years of national data from the National Inpatient Sample to identify adult hospitalizations for PUD, distinguishing perforated cases using International Classification of Diseases-10-CM codes. PSM was performed using 1:1 nearest neighbor matching without replacement, adjusting for demographics (age, sex, race/ethnicity) and multiple comorbidities, including cardiovascular disease, diabetes, chronic kidney disease, liver disease, chronic obstructive pulmonary disease, obesity, and coronavirus disease 2019. Outcomes assessed included in-hospital mortality, sepsis, septic shock, acute kidney injury (AKI), prolonged length of stay (LOS ≥7 days), and elevated healthcare costs. Matched outcomes were compared using the Pearson Chi-Square test. Results: Of 2,561,379 PUD hospitalizations, perforation developed in 207,970 (8.1%). After matching, 40,413 patient pairs were identified. Perforated PUD was associated with significantly worse outcomes. In-hospital mortality was higher in the perforated group (7.2% vs 2.9%, P < 0.001), as were sepsis (21.8% vs 7.1%, P < 0.001), septic shock (12.9% vs 2.9%, P < 0.001), and AKI (29.5% vs 21.2%, P < 0.001). Patients with perforated PUD were also noted to have prolonged hospitalization (LOS ≥7 days: 45.6% vs 28.0%, P < 0.001), higher inflation-adjusted total hospital charges (≥$40,000: 20.9% vs 9.9%, P < 0.001), and increased cost of hospitalization to the patient (≥$12,000: 69.1% vs 45.1%, P < 0.001). Conclusion: Perforation in PUD remains an independent association of adverse clinical outcomes and greater healthcare utilization despite adjusting for a wide range of comorbidities using PSM. These findings highlight the urgent need for preventive strategies, early diagnosis, and aggressive management in patients at risk for ulcer perforation, as well as the importance of resource planning for this high-risk group.