A Population-Based Cohort Study Examining the Long-term Risk of Repeated Surgery in Non- Helicobacter pylori -Infected P
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ORIGINAL ARTICLE
A Population-Based Cohort Study Examining the Long-term Risk of Repeated Surgery in Non-Helicobacter pylori-Infected PPU Patients Who Underwent Simple Closure Shih-Chi Wu 1,2
&
William Tzu-Liang Chen 3 & Chih-Hsin Muo 4 & Chung Y. Hsu 1
Received: 11 April 2019 / Accepted: 21 October 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Objectives The management of perforated peptic ulcer (PPU) has shifted from vagotomy/drainage to simple closure, followed by postoperative proton pump inhibitors (PPIs) and Helicobacter pylori (HP) eradication. Few studies have focused on the longterm impacts of this trend shift. We hypothesize that simple closure with PPIs is sufficient and does not carry an elevated rate of repeated surgery in non-HP-infected PPU patients. Methods Hospitalized PPU patients who underwent simple closure or truncal vagotomy/pyloroplasty (TVP) in the National Health Insurance Research Database (NHIRD) from 2000 to 2008 were collected. The index date was defined as the date of ulcer admission. Patients who underwent other ulcer surgeries (e.g., gastrectomy, highly or selective vagotomy), who had a history of HP infection, or who were < 18 or > 100 years old were excluded. Additionally, the distributions of postoperative nonsteroidal anti-inflammatory drug (NSAID) and PPI use were calculated using the Longitudinal Health Insurance Database (LHID). Results After exclusion, a total of 66,413 patients were enrolled. There were 7232 (10.9%) patients who underwent TVP and 59,181 (89.1%) patients who underwent simple closure. The incidences of repeated ulcer-associated surgery were 5.10 and 23.05 versus 5.11 and 15.77 per 1000 person-years in the TVP cohort vs. the simple closure cohort before and after propensity score matching, respectively. When adjusted for age, sex, comorbidity, and Charlson comorbidity index score, the TVP cohort had a 68% (HR) and 66% (sHR) decreased risk compared with the simple closure cohort before propensity score matching, with a 67% decreased risk after propensity score matching in Cox proportional subdistribution hazard analysis and a 66% decreased risk in Fine-Gray proportional subdistribution hazard analysis. The LHID analysis showed a lower rate of postoperative NSAID use and a higher rate of postoperative PPI use in simple closure patients. Conclusion Our findings suggest that in the Asian population, simple closure increases the risk of repeated ulcer-associated surgery in non-HP-infected PPU patients compared with TVP patients. However, further studies are warranted. Keywords Perforated peptic ulcer . Simple closure . Vagotomy . Recurrent perforation
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-019-04442-3) contains supplementary material, which is available to authorized users. * Shih-Chi Wu [email protected]
1
Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
2
Trauma and Emergency Center, China Medical University Hospital, No. 2
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