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Risk factors of perioperative mortality from complicated peptic ulcer disease in Africa: systematic review and meta-analysis
  1. Sarah Peiffer1,
  2. Matthew Pelton1,
  3. Laura Keeney1,
  4. Eustina G Kwon1,
  5. Richard Ofosu-Okromah2,
  6. Yubraj Acharya3,
  7. Vernon M Chinchilli1,
  8. David I Soybel1,
  9. John S Oh1,
  10. Paddy Ssentongo1,4,5
  1. 1Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
  2. 2Department of Surgery, Eastern Regional Hospital, Koforidua, Ghana
  3. 3Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, USA
  4. 4Department of Public Health Science, Penn State College of Medicine, Hershey, Pennsylvania, USA
  5. 5Center for Neural Engineering, Department of Engineering, Science and Mechanics, Pennsylvania State University, University Park, Pennsylvania, USA
  1. Correspondence to Dr Paddy Ssentongo; pssentongo{at}


Introduction In 2013, peptic ulcer disease (PUD) caused over 300 000 deaths globally. Low-income and middle-income countries are disproportionately affected. However, there is limited information regarding risk factors of perioperative mortality rates in these countries.

Objective To assess perioperative mortality rates from complicated PUD in Africa and associated risk factors.

Design We performed a systematic review and a random-effect meta-analysis of literature describing surgical management of complicated PUD in Africa. We used subgroup analysis and meta-regression analyses to investigate sources of variations in the mortality rates and to assess the risk factors contributing to mortality.

Results From 95 published reports, 10 037 patients underwent surgery for complicated PUD. The majority of the ulcers (78%) were duodenal, followed by gastric (14%). Forty-one per cent of operations were for perforation, 22% for obstruction and 9% for bleeding. The operations consisted of vagotomy (38%), primary repair (34%), resection and reconstruction (12%), and drainage procedures (6%). The overall PUD mortality rate was 6.6% (95% CI 5.4% to 8.1%). It increased to 9.7% (95% CI 7.1 to 13.0) when we limited the analysis to studies published after the year 2000. The correlation was higher between perforated PUD and mortality rates (r=0.41, p<0.0001) than for bleeding PUD and mortality rates (r=0.32, p=0.001). Non-significant differences in mortality rates existed between sub-Saharan Africa (SSA) and North Africa and within SSA.

Conclusion Perioperative mortality rates from complicated PUD in Africa are substantially high and could be increasing over time, and there are possible regional differences.

  • peptic ulcer disease
  • perforation
  • bleeding
  • obstruction
  • Africa

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  • SP and MP contributed equally.

  • Contributors PS, LK and JSO conceived the initial study idea. PS carried out the statistical analyses and drafted the manuscript. SP, MP, EGK and RO-O prepared the data and participated in the statistical analyses and critical revision of the manuscript. VMC and YA contributed to the statistical analyses, drafting and critical revision of the manuscript. JSO, LK and DIS contributed to the critical revision of the manuscript. All authors approved the final manuscript version to be published and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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