Research article

Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study

Steffen Christensen¹ , Anders Riis¹ , Mette Nørgaard¹ , Henrik T Sørensen^1,2,3 and Reimar W Thomsen¹

¹Department of Clinical Epidemiology, Aalborg and Aarhus Hospital, Aarhus University Hospital, Denmark

²Department of Epidemiology, School of Public Health, Boston University, MA, USA

³Department of Medicine V, Aarhus University Hospital, Denmark

author email corresponding author email

BMC Geriatrics 2007, 7:8doi:10.1186/1471-2318-7-8

Published:	17 April 2007

Abstract

Background

Mortality after perforated and bleeding peptic ulcer increases with age. Limited data exist on how the higher burden of comorbidity among elderly patients affects this association. We aimed to examine the association of age with short-term mortality after perforated and bleeding peptic ulcer and to determine the impact of comorbidity on this association.

Methods

In this population-based cohort study in three Danish counties between 1991 and 2003 we identified two cohorts of patients: those hospitalized with a first-time discharge diagnosis of perforated peptic ulcer and those with bleeding peptic ulcer. The diagnoses were ascertained from hospital discharge registries and mortality through the Danish Civil Registration System. Information on comorbidity and use of ulcer-related drugs was obtained through administrative medical databases. We computed age-, gender- and comorbidity-standardized 30-day mortality rates and used Cox's regression to estimate adjusted 30-day mortality rate ratios (MRR) for elderly compared with younger patients.

Results

Among 2,061 patients with perforated peptic ulcer, 743 (36%) were 65–79 years old and 513 patients (25%) were aged 80+ years. Standardized 30-day mortality was 8.9% among patients younger than 65 years rising to 44.6% among patients aged 80+ years, corresponding to an adjusted MRR of 5.3 (95% CI: 4.0–7.0). Among 7,232 patients with bleeding peptic ulcer 2,372 (33%) were aged 80+ years. Standardized 30-day mortality among patients younger than 65 was 4.3% compared with 16.9% among patients aged 80+ years, corresponding to an adjusted MRR of 3.7 (95% CI: 2.9–4.7). Analyses stratified by comorbidity consistently showed high MRRs among elderly patients, regardless of comorbidity level.

Conclusion

Ageing is a strong predictor for a poor outcome after perforated and bleeding peptic ulcer independently of comorbidity.