P4059 - From Perforation to Mortality: National Predictors of In-Hospital Death in Perforated Peptic Ulcer Disease

Adishwar Rao, MD, MPH¹, Akriti Agrawal, MD, MPH², Omar Al Ta’ani, MD³, Hassam Ali, MD⁴, Saqr Alsakarneh, MD, MSc⁵, Sheza Malik, MD⁶, Umar Hayat, MD⁷, Fariha Hasan, MD⁸, Hareesha Rishab Bharadwaj, ⁹, Dushyant S. Dahiya, MD¹⁰
1Guthrie Robert Packer Hospital, Sayre, PA, Sayre, PA; 2Guthrie Robert Packer Hospital, Sayre, PA; 3Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA, Pittsburgh, PA; 4East Carolina University/Brody School of Medicine, Greenville, NC; 5Mayo Clinic, Rochester, MN; 6Emory University, Atlanta, GA; 7Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; 8Cooper University Hospital, Camden, NJ; 9The University of Manchester, Manchester, England, United Kingdom; 10University of Kansas School of Medicine, Kansas City, KS

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 ICD-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.

Discussion: 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.

Disclosures:
Adishwar Rao indicated no relevant financial relationships.
Akriti Agrawal indicated no relevant financial relationships.
Omar Al Ta’ani indicated no relevant financial relationships.
Hassam Ali indicated no relevant financial relationships.
Saqr Alsakarneh indicated no relevant financial relationships.
Sheza Malik indicated no relevant financial relationships.
Umar Hayat indicated no relevant financial relationships.
Fariha Hasan indicated no relevant financial relationships.
Hareesha Rishab Bharadwaj indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.

Adishwar Rao, MD, MPH¹, Akriti Agrawal, MD, MPH², Omar Al Ta’ani, MD³, Hassam Ali, MD⁴, Saqr Alsakarneh, MD, MSc⁵, Sheza Malik, MD⁶, Umar Hayat, MD⁷, Fariha Hasan, MD⁸, Hareesha Rishab Bharadwaj, ⁹, Dushyant S. Dahiya, MD¹⁰. P4059 - From Perforation to Mortality: National Predictors of In-Hospital Death in Perforated Peptic Ulcer Disease, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.