Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation

Background: Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU. Methods: This was an externally controlled multicentre trial set in seven gastrointestinal departments in Denmark. Consecutive patients who underwent surgery for gastric or duodenal PPU between 1 January 2008 and 31 December 2009 were treated according to a multimodal and multidisciplinary evidence-based perioperative care protocol. The 30-day mortality rate in this group was compared with rates in historical and concurrent national controls. Results: The 30-daymortality rate following PPU was 17.1 per cent in the intervention group, compared with 27.0 per cent in the three control groups (P = 0.005). This corresponded to a relative risk of 0.63 (95 per cent confidence interval 0.41 to 0.97), a relative risk reduction of 37 (5 to 58) per cent and a number needed to treat of 10 (6 to 38). Conclusion: The 30-day mortality rate in patients with PPU was reduced by more than one-third after the implementation of a multimodal and multidisciplinary perioperative care protocol, compared with conventional treatment. Registration number: NCT00624169 (http://www.clinicaltrials.gov).