The utility of the Boey scoring system in predicting postoperative morbidity and mortality in patients with perforative peritonitis

Prameyratna R. Kadam

doi:10.18203/2349-2902.isj20261572

Authors

Prameyratna R. Kadam BVDUMC and H, Sangli, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20261572

Keywords:

Boey scoring system, Peptic ulcer perforation, Perforation peritonitis, Predictive scoring system, Risk stratification

Abstract

Background: Perforated peptic ulcer remains a common surgical emergency despite advances in medical therapy. The Boey score-based on duration of perforation >24 hours, preoperative shock, and significant comorbidity-has been proposed as a simple prognostic tool for postoperative outcomes.

Methods: In this prospective observational cohort study conducted over 18 months at a tertiary rural hospital, 46 consecutive patients with confirmed perforated peptic ulcer underwent urgent open repair with primary closure and pedicled omentoplasty. Boey scores (0-3) were calculated at admission, and patients were classified as low risk (0-1) or high risk (2-3). Demographic, clinical, radiographic, operative and postoperative data were recorded. Associations between Boey score components and mortality were analyzed using chi-square/Fisher’s exact tests and multivariate logistic regression. Diagnostic performance was assessed by ROC analysis, sensitivity, specificity, predictive values, and Likelihood ratios (LR).

Results: Forty-six patients (mean age 52.07±15.97 years; 73.9% male) were studied; overall mortality was 13.0% (6/46). Comorbidities were present in 14 (30.4%). Boey scores: 0 (n=13, 28.3%), 1 (n=19, 41.3%), 2 (n=11, 23.9%), 3 (n=3, 6.5%); high scores (2-3) comprised 14 (30.4%). Mortality increased with Boey score (score 2: 27.3%; score 3: 66.7%). Preoperative shock was significantly associated with death (p=0.009); delayed presentation (>24 h) was more frequent among deaths but not significant (p=0.198). Boey score and age were independent predictors; AUC for Boey=0.792 (p=0.022).

Conclusions: The Boey score is a practical and moderately accurate predictor of postoperative mortality in perforated peptic ulcer patients; preoperative shock is the strongest individual predictor, and delayed presentation and comorbidity further increased risk.

References

Boey J, Choi SKY, Poon A, Algaratnam TT. Risk stratification in perforated duodenal ulcers. Ann Surg. 1987;205(1):22-6.

Lee FYJ, Leung KL, Lai BSP, Ng SSM, Dexter S, Lau WY. Predicting mortality and morbidity of patients operated on for perforated peptic ulcers. Arch Surg. 2001;136(1):90-3.

Svanes C, Salvesen H, Stangeland I, Svanes K, Soreide O. Perforated peptic ulcer over 56 years, time trends in patients and disease characteristics. Gut. 1993;34(12):1666-71.

Taha AS, Dahill S, Nakshabendi I, Lee FD, Sturrock RD, Rusell RI. Duodenal histology, ulceration, and Helicobacter pylori in the presence or absence of non-steroidal anti-inflammatory drugs. Gut. 1993;34(9):1162-6.

Jordan PH, Thornby J. Perforated Pyloroduodenal Ulcers Long-Term Results with Omental Patch Closure and Parietal Cell Vagotomy. Ann Surg. 1995;221(5):479-88.

Chalya PL, Mabula JB, Koy M, Mehembe MD, Jaka HM, Kabangila R, et al. Clinical profile and outcome of surgical treatment of perforated peptic ulcers in northwestern tanzania: a tertiary hospital experience. World J Emergency Surg. 2011;6:31.

Ugochukwu AI, Amu OC, Nzegwu MA, Dilibe UC. Acute perforated peptic ulcer: on clinical experience in an urban tertiary hospital in south east nigeria. Int J Surg. 2013;11(3):223-7.

Unver M, Fırat O, Unalp OV, Uguz A, Gumus T, Sezer TO, et al. Prognostic factors in peptic ulcer perforations: a retrospective 14-year study. Int. Surg. 2015;100:942-8.

Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009;33(1):80-5.

Tas I, Ulger BV, Onder A, Kapan M, Bozdag Z. Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulusal Cer Derg. 2015;31:20-5.

Gona SK, Alassan MK, Marcellin KG, Henriette KY, Adama C, Toussaint A, et al. Postoperative morbidity and mortality of perforated peptic ulcer: retrospective cohort study of risk factors among black africans in côte d’ivoire. Gastroenterol Res Pract. 2016;2016.

Soreide K, Thorsen K, Soreide JA. Predicting outcomes in patients with perforated gastroduodenal ulcers: artiﬁcial neural network modelling indicates a highly complex disease. Eur J Trauma Emerg Surg. 2015;41:91-8.

Nichakankitti N, Athigakunagorn J. The accuracy of prognostic scoring systems for post-operative morbidity and mortality in patients with perforated peptic ulcer. Int Surg J. 2016;3(1):286-90.

Buck DL, Vester-Andersen M, Moller MH. Accuracy of clinical prediction rules in peptic ulcer perforation: an observational study. Scand J Gastroenterol. 2012;47(1):28-35.

Anbalakan K, Chua D, Pandya GJ, Shelat VG. Five year experience in management of perforated peptic ulcer and validation of common mortality risk prediction models- are existing models sufficient? A retrospective cohort study. Int J Surg. 2015;14:38-44.

Sedighi I. Interpretation of diagnostic tests: likelihood ratio vs. Predictive value. Iran J Pediatr. 2013;23(6):717.