Changes in Surgical Treatment of Peptic Ulcer Disease Within a Veterans Hospital in the 1970s and the 1980s

To determine if the surgical treatment of peptic ulcer disease within a Veterans Administration hospital has changed over the past decade, we compared two groups of patients. Group 1 (n=104) had surgery between 1974 and 1977 and group 2 (n=61) had surgery between 1984 and 1987. In group 1, 49 (47%) ulcer operations were performed for chronic symptoms, while in group 2, 11 (18%) were performed for nonemergent reasons. The remaining 55 (53%) patients in group 1 and 50 (82%) in group 2 had operations for complications of peptic ulcer. When expressed per 1000 admissions, the rates of operations for complications were similar (1.08 vs 1.1). The relative proportions of perforation, bleeding, or obstruction were similar for patients in the two groups, as was the American Society of Anesthesiologist's Physical Status rating (3.1 vs 3.2). The fitness score, a scale for assessing preoperative risk with 10 representing the greatest risk, was also similar (6.7 vs 6.8). An American Society of Anesthesiologist's Physical Status value of greater than 3 and a fitness score of greater than 6 indicate that these patients were at high risk with an expected operative mortality of greater than 25%. In fact, the mortalities in groups 1 and 2 for patients having emergency operations for complications were 29% and 30%, respectively. The marked reduction in elective ulcer operations observed in our institution may be due to several factors, including better nonoperative therapy (eg, histamine receptor antagonists), physician preference for nonoperative treatment of chronic ulcers, or a reduced incidence of chronic ulcer within our population. However, the number of emergency operations for complications of ulcer has remained constant. These complications occur in poor-risk patients with concomitant illness, and the operative mortality for these patients is high.