Does resuscitation in perforation-operation interval modify the mortality in duodenal perforations?

Objective: An attempt to analyze why in spite of prolonged perforation-operation (PO) interval mortality in patients of perforated duodenal ulcers is less in some patients and whether resuscitative measures in PO interval infl uences mortality particularly in a rural hospital. Materials and Methods: A retrospective analysis of 81 cases of perforated duodenal ulcers presenting in the surgical clinic in a rural medical college which is also a tertiary referral center. Resuscitation, if received in the PO interval was recorded, and a corrected score was calculated and compared statistically with the conventional Boey score. Results were analyzed using Microsoft Excel and SPSS 22 software. Results: Sample size of 81 patients had 70 referred and 11 direct patients. Six out of 11 direct patients succumbed (P = 0.545) and six out of 70 patients succumbed in the referred group (P = 0.086) suggesting that patients presenting directly to the tertiary center with a prolonged PO interval without any intervening resuscitation the prognosis is poor whereas a delayed PO with intervening medical intervention has a better prognosis. The PO interval was 23-168 h with a mean of 42.12 (standard deviation 26.86). Conclusion: In a rural referral center, the resuscitation done in the PO interval is significant as the prognosis is better in the group of patients resuscitated in the PO interval even if there is a delay in the surgical intervention whereas the mortality is higher in those group of patients who have come directly to the center and subjected to surgical procedure, but without any resuscitation in the PO interval. Hence, resuscitation in PO interval is paramount for a better prognosis.