Determinants of morbidity and mortality in perforated peptic ulcer disease: A retrospective study at Jimma University Medical Center, Ethiopia

Background Peptic ulcer disease (PUD) is a common disease, which is a global public health concern. Whereas perforated peptic ulcer disease (PPUD) is a significant surgical emergency in low-resource settings, with high morbidity and mortality. Risk factors and outcomes differ from high-income countries due to variations in healthcare access, patient behaviour, and surgical practice. Materials and methods A tertiary hospital-based, retrospective, cross-sectional study was conducted over 5 years. The sample size (n = 102) was calculated using a single population proportion formula, based on expected PPUD outcome, a 95% confidence level, and 5% margin of error. Demographic, clinical, intraoperative, and postoperative data were analyzed. Associations between patient factors, perforation characteristics, surgical procedures, and outcomes were assessed using multivariate logistic regression. Result Most patients were young males (mean age 35.4 years). 57.8% of the patients presented more than twenty-four hours later. Eighty-one patients (79.4%) had perforations on the anterior first part of the duodenum. For the majority, 86(84.3%) of the patients repair was done with omental pedicle alone. Post-operative complications were recorded in thirty seven (36.3) patients. Significant predictors of adverse outcomes were delayed presentation, advanced age, hypotension at admission, large perforation size, and type of surgical procedure. Conclusion PPUD in our setting predominantly affects young males and duodenal ulcers whereas delayed presentation contributed to high morbidity. Pedicled omental patch repair remains the mainstay of treatment. In order to reduce complications and mortality in resource-limited settings, improving early recognition, timely referral, and perioperative care are crucial.