In this study we sought to identify changes in the etiology and surgical treatment of acute gastrointestinal perforations in the United States over the past 20 years. We performed a retrospective review of the Nationwide Inpatient Sample from January 1, 1988, through December 31, 2007. We first identified all patients with gastrointestinal perforations, the perforated organ, and treatment rendered. During the study period, 550,132 patients experienced a gastrointestinal perforation for a mean rate of 3.9 cases per 1,000 discharges. Total number of perforations rose significantly over the study period, yet surgical procedures were performed in less than half of the patients (47.6%). The most common surgical procedures for gastrointestinal perforation were colorectal in origin (38.3%), upper gastrointestinal tract (30.0%), small intestine (29.2%), esophagus (3.0%), and anus (0.1%). At study end, colorectal procedures for perforation were the most commonly performed (40.4%), whereas upper gastrointestinal procedures experienced the greatest decline. In conclusion, our data demonstrate a decline in procedures for upper gastrointestinal perforation and an increase in colorectal procedures during the two-decade study period. These data should be used to assist in the training of acute care surgeons.
Get full access to this article
View all access options for this article.
References
1.
BashinskayaB., NahedB.V., RedjalN.Trends in peptic ulcer disease and the identification of Helicobacter pylori as a causative organism: population-based estimates from the US Nationwide Inpatient Sample.J Glob Infect Dis.2011; 3: 366–70.
2.
ReubenB.C., StoddardG., GlasgowR., NeumayerL.A.Trends and predictors for vagotomy when performing oversew of acute bleeding duodenal ulcer in the United States.J Gastrointest Surg2007; 11: 22–8.
3.
MooreE.E., MaierR.V., HoytD.B.Acute care surgery: eraritjaritjaka.Am Coll Surg.2006; 202: 698–701.
4.
The Committee on Acute Care Surgery American Association for the Surgery of Trauma.The acute care surgery curriculum.J Trauma2007; 62: 553–6.
5.
Nationwide Inpatient SampleH.C.U.P. (NIS). Healthcare Cost and Utilization Project (HCUP). 2007–2009.Rockville, MD: Agency for Healthcare Research and Quality. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed November 3, 2011.
6.
DimickJ.B., WainessR.M., CowanJ.A.National trends in the use and outcomes of hepatic resection.J Am Coll Surg2004; 199: 31–8.
7.
RicciardiR., VirnigB.A., OgilvieJ.W.Volume–outcome relationship for coronary artery bypass grafting in an era of decreasing volume.Arch Surg2008; 143: 338–44.
8.
ShenJ.J., WashingtonE.L., Aponte-SotoL.Racial disparities in the pathogenesis and outcomes for patients with ischemic stroke.Manag Care Interface2004; 17: 28–34.
9.
Surveillance, Epidemiology, and End Results Program website. Statistical Research & Applications Branch—Joinpoint Home. Available at: http://srab.cancer.gov/joinpoint/. Accessed February 20, 2006.
10.
KimH.J., FayM.P., FeuerE.J., MidthuneD.N.Permutation tests for joinpoint regression with applications to cancer rates.Stat Med2000; 19: 335–51. Erratum in Stat Med 2001; 20: 655.
11.
LanasA., García-RodríguezL.A., Polo-TomásM.Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice.Am J Gastroenterol2009; 104: 1633–41.
12.
LanasA., García-RodríguezL.A., Polo-TomásM.The changing face of hospitalization due to gastrointestinal bleeding and perforation.Aliment Pharmacol Ther2011; 33: 585–91.
13.
HermanssonM., EkedahlA., RanstamJ.Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974–2002.BMC Gastroenterol2009; 9: 25.
14.
RicciardiR., BaxterN.N., ReadT.E.Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis?Dis Colon Rectum2009; 52: 1558–63.
