The Value of Boey, PULP and ASA Scores in Predicting 30-Day Mortality and Morbidity: A Single-Center Retrospective Study

Background/Objectives: A perforated peptic ulcer (PPU) is a life-threatening surgical emergency, with high levels of mortality and morbidity reported in the literature. Recognizing which patients are at most risk of developing complications or losing their life is of great importance and, as such, several scoring systems have been developed to try to predict it. This study aims to compare the predictive value of three of the most used scores (Boey, PULP and ASA scores) in assessing 30-day morbidity and mortality in patients with PPU at our hospital. Methods: This single-center retrospective study included all the patients that were surgically treated for PPU at our hospital between 1 January 2020 and 31 December 2024 (n = 76). Results: Within 30 days of index surgery, a total of 5 patients (7%) died and 24 (32%) suffered from some form of complication. Both the Boey and PULP scores demonstrated good predictive ability, with an area under curve (AUC) of >0.95 for mortality. With regard to morbidity, the Boey score achieved the best results (being the only one with AUC > 0.9), followed closely by the PULP score. Meanwhile, the ASA classification fell short of the other scores but still showed good results. Conclusions: The Boey score demonstrated the most balanced and reliable performance in predicting both mortality and morbidity. The PULP score also showed good accuracy for the mortality prediction, but at the cost of a slightly lower specificity. Altogether, both the Boey and PULP scores appear to be robust tools for short-term risk stratification for PPU complications.