Massachusetts Chapter of the American College of Surgeons

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Utility of Postoperative Imaging in Perforated Peptic Ulcer Disease
Ya Zhou, Aixa Perez, Antonio Lam, Brandon Smith, John Romanelli
Department of Surgery, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA

We hypothesized that the use of routine postoperative imaging, specifically an upper GI study, does not improve outcomes but rather prolongs time to enteric feeding and hospital length of stay.

We performed an IRB approved retrospective study at a single tertiary academic teaching hospital, identifying adult patients admitted for PPU between 1/1/2010 and 1/1/2019. Primary outcomes were time to enteric feeding and time to discharge.

145 patients met inclusion criteria for this study, of which 131 patients underwent operative repair. The majority of patients underwent postoperative imaging (74.6 and 70.9% for gastric and duodenal perforations respectively). In patients with gastric perforation, those without postop imaging were older with higher ASA class. There were no significant differences between baseline demographics in those with and without postoperative imaging in patients with duodenal perforation. In both gastric and duodenal perforations, there was no significant difference in time to discharge. There was a non-statistically significant trend towards earlier enteric feeding in patients who did not undergo postop imaging. Patients with gastric perforations who did not receive postoperative imaging had a higher mortality rate.

Except for the slightly higher mortality rate in patients with gastric perforation who underwent postop imaging, there were no significant differences in outcomes with a trend towards shorter time to enteric feeding in patients who did not receive postop imaging.

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