Predictive validity of the Boey scoring system for postoperative outcomes in perforated peptic ulcer disease: a prospective study from a tertiary center of Nepal

Samrat Shrestha; Mecklina Shrestha; Prahasan Rai; Suresh Maharjan

doi:10.18203/2349-2902.isj20253008

Authors

Samrat Shrestha Department of General Surgery, National Academy of Medical Sciences, NAMS, Bir Hospital, Kathmandu, Nepal https://orcid.org/0009-0003-9153-3418
Mecklina Shrestha Department of Pathology, College of Medical Sciences (CoMS), Bharatpur, Nepal https://orcid.org/0009-0009-6029-0533
Prahasan Rai Department of General Surgery, National Academy of Medical Sciences, NAMS, Bir Hospital, Kathmandu, Nepal
Suresh Maharjan Department of General Surgery, National Academy of Medical Sciences, NAMS, Bir Hospital, Kathmandu, Nepal https://orcid.org/0009-0001-3173-3034

DOI:

https://doi.org/10.18203/2349-2902.isj20253008

Keywords:

Boey score, Morbidity, Mortality, Hospital stay, Perforation, Surgery, Peptic ulcer, Postoperative outcomes

Abstract

Background: Perforated peptic ulcer (PPU) is a surgical emergency with high morbidity and mortality, making risk stratification critical. The Boey score (comorbidity, preoperative shock (SBP <90 mmHg), presentation delay >24 h) is a simple preoperative tool for predicting PPU outcomes.

Methods: Authors conducted a prospective observational study (February 2023–Mar 2025) in Kathmandu, including 94 adults (18-80 years) undergoing emergency laparotomy for PPU. We recorded each patient’s demographics and calculated the Boey score. All patients received standard surgical repair (Graham’s patch and lavage). Outcomes were 30-day postoperative morbidity, mortality and hospital stay.

Results: Patients (mean age 40.05±18.17 years, 92.6% male) were stratified: Boey 0 (31.9%), Boey 1 (45.7%), Boey 2 (11.7%), Boey 3 (10.6%). Overall morbidity was 42.6%, increasing significantly: 13.3% (score 0), 46.5% (score 1), 72.7% (score 2), 80.0% (score 3) (p<0.001). Overall, 30-day mortality was 9.57%, rising sharply with Boey score: 0% (score 0), 4.65% (score 1), 9.1% (score 2), 60% (score 3) (p<0.001). Boey score ≥2 predicted morbidity with 40.0% sensitivity and 90.7% specificity (AUC=0.755, 95% CI 0.65-0.85). Boey score=3 predicted mortality with 66.7% sensitivity and 95.3% specificity (AUC=0.882, 95% CI 0.76-0.97). The mean hospital stay was 9.0±3.62 days.

Conclusions: In this study, a higher Boey score strongly predicted worse postoperative outcomes in PPU. Patients with Boey ≥2 had substantially higher complication and death rates. The simple Boey score is a valid preoperative triage tool for PPU in resource-limited settings.

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