Predictors of Mortality in Perforated Peptic Ulcer Surgery in Young Male Patients: A Multicenter Study from Yemen

Background/Objectives: Perforated peptic ulcer (PPU) remains a significant surgical emergency, with substantial morbidity and mortality, particularly in resource-limited set-tings. This study aimed to determine the 30-day morbidity and mortality rates following surgery for PPU in a predominantly young male population in conflict-affected Yemen and to identify predictors of adverse outcomes in this specific healthcare environment. Methods: We conducted a prospective multicenter observational study across four major governmental hospitals in Sana'a, Yemen. All adult patients who underwent surgery for PPU between February 2023 and February 2024 were included in the study. The primary outcomes were 30-day mortality and complications according to the Clavien-Dindo classification. Univariate and multivariate analyses were performed to identify the predictors of adverse outcomes. Results: A total of 108 patients (97.2% male) with a mean age of 39.6 years were included. The overall 30-day mortality rate was 11.1% (12/108) and the 30-day morbidity rate was 44.4% (48/108). Complete separation of mortality outcomes was observed, with all 12 deaths occurring in patients presenting with shock and acute kidney injury, identifying an extremely high-risk phenotype requiring validation in larger studies. Multivariate analysis for morbidity identified shock on admission (odds ratio [OR] 9.38, 95% confidence interval [CI] 2.73-32.26), delayed presentation (OR 1.03 per hour, 95% CI 1.01-1.05), and in-creasing age (OR 1.04 per year, 95% CI 1.00-1.07) as significant independent predictors. Conclusions: Surgery for PPU in this young male population from conflict-affected Yemen was associated with substantial morbidity and mortality rates. The observed complete separation of mortality outcomes, while requiring validation in larger and more diverse populations, may inform risk stratification in resource-limited settings. These findings contribute to the understanding of PPU outcomes in conflict-affected environments; how-ever, their generalizability to other populations and healthcare systems requires further investigation.