Boey score as a predictor of early postoperative outcome among perforated peptic ulcer disease patients in Mulago National Referral Hospital: a retrospective cohort study.

Abstract

Back ground: Perforated Peptic Ulcers (PPU) is a serious complication of Peptic Ulcer Disease (PUD) which is estimated to contribute to about 35% of emergency abdominal operations for peritonitis in Mulago National Referral Hospital. Morbidity and mortality from this condition remains high in many settings. Several prognostic scores among which is Boey score have been designed for this condition. To date none of these prognostic scores has been validated in Mulago NRH. Study objective: This study sought to determine the ability of Boey score in predicting in-hospital postoperative outcome of patients surgically managed for PPU in Mulago National Referral Hospital. Factors associated with adverse postoperative outcome of PPU patients were also investigated. Methods: This was a retrospective cohort study which reviewed charts of 247 patients who were intraoperatively diagnosed and surgically managed for PPU in Mulago NRH in the last 7 years. Chart review was done to collect data which included; demographics, medical history, clinical parameters (from which Boey score was assigned to the study subjects) and postoperative outcome (complications and/or death). Univariate analysis was done to summarize categorical variables using frequencies, proportions, and percentages. The incidence of the outcome was 20.4% and so we used a generalized modified Poisson regression model with robust standard errors to analyze factors associated with adverse postoperative outcome of PPU patients. Sensitivity and Specificity of Boey score was estimated from ROC curve analysis. Results: 93.2% of the study participants were males and predominantly younger than 60 years of age. Overall postoperative morbidity and mortality for our study was 20.4% and was predominated by occurrence of surgical site and related infections. Boey score of 2 was found to be statistically significantly associated with adverse postoperative outcome with; [a RR, p-value; 7.5, 0.043,]. Conclusion: Boey score had AUC of 0.6221 and sensitivity and specificity of 40% and 80% respectively for PPU patients in our setting, this makes it a fairly good prognostic tool that can be used preoperatively to risk stratify perforated peptic ulcer disease patients. Boey score of 2 was the only factor significantly associated with adverse postoperative outcome of PPU patients.