EGS P02 The long term impact of service re-organisation on outcomes for patients with complicated peptic ulcer disease


 
 
 20 years ago acute surgical services were re-organised in our region to deliver subspecialist care of upper-gastrointestinal emergencies. Improved outcomes were reported as a result. Currently the unit has 24-hour availability for interventional and diagnostic radiology, emergency endoscopy and a specialist oesophago-gastric consultant surgeon. The aims of this study are to determine if, a decade after a major service re-organisation, any further improvements have been achieved in short-term outcomes and to provide long-term survival figures for this group of patients.
 
 
 
 All patients admitted during a 62-month period from January 2010-February 2015, corresponding in duration and exactly a decade later than the previous report following service re-organisation, were identified from a prospectively compiled database.
 
 
 
 287 patients were admitted during the study period. 235 patients were admitted with ulcer perforation and 52 patients underwent surgery for bleeding.
 Perforation. 8 patients (8/235, 3.4%) received end of life care. 37 patients (37/235, 15.7%) had initial conservative management. 191 (191/235, 81.3%) patients underwent operation (includes 1 patient with failed conservative management). 18 patients (18/191, 9.4%) died post-operatively. No patients selected for conservative management died. Within 5 years following discharge a further 34 patients died. 50% (17/34) of these were due to cancer. Actual 5-year survival was 73.3% (165/225, 10 patients lost to follow up). Comparing with the period following subspecialisation, overall in-hospital mortality was 10.4% vs 11.1% (14/135 vs 26/235) p=0.84, in-hospital mortality following surgery 7.9% vs 9.4% (9/114 vs 18/191) p=0.65 and in-hospital mortality following conservative management 23.8% vs 0% (5/21 vs 0/36) p=0.005.
 Bleeding. In-hospital mortality was 25% (13/52). This was not significantly different from the rate reported following service reorganisation, 23.5% (12/51) vs 25% (13/52) p=0.86. Within 5 years following discharge a further 12 patients died. 58% (7/12) of these were due to cancer. Actual 5-year survival was 51.9% (27/52 patients alive).
 
 
 
 This study demonstrates that no improvement in surgical outcome in patients with complicated peptic ulcer disease has been achieved despite the delivery of what may be considered an optimal service. A significant improvement in outcome in patients selected as suitable for conservative management has been seen. 5-year survival figures for patients admitted with either perforation or bleeding are poor with cancer the most common cause of death within 5 years following discharge.
