Quality-of-care initiative in patients treated surgically for perforated peptic ulcer

Background: Mortality and morbidity are considerable after treatment for perforated peptic ulcer (PPU). Since 2003, a Danish nationwide quality-of-care (QOC) improvement initiative has focused on reducing preoperative delay, and improving perioperative monitoring and care for patients with PPU. The present study reports the results of this initiative. Methods: This was a nationwide cohort study based on prospectively collected data, involving all hospitals caring for patients with PPU in Denmark. Details of patients treated surgically for PPU between September 2004 and August 2011 were reported to the Danish Clinical Register of Emergency Surgery. Changes in baseline patient characteristics and in seven QOC indicators are presented, including relative risks (RRs) for achievement of the indicators. Results: The study included 2989 patients. An increasing number fulfilled the following four QOC indicators in 2010-2011 compared with the first 2 years of monitoring: preoperative delay no more than 6 h (59.0 versus 54.0 per cent; P = 0.030), daily monitoring of bodyweight (48.0 versus 29.0 per cent; P < 0.001), daily monitoring of fluid balance (79.0 versus 74.0 per cent; P = 0.010) and daily monitoring of vital signs (80.0 versus 68.0 per cent; P < 0.001). A lower proportion of patients had discontinuation of routine prophylactic antibiotics (82.0 versus 90.0 per cent; P < 0.001). Adjusted 30-day mortality decreased non-significantly from 2005-2006 to 2010-2011 (adjusted RR 0.87, 95 per cent confidence interval 0.76 to 1.00), whereas the rate of reoperative surgery remained unchanged (adjusted RR 0.98, 0.78 to 1.23). Conclusion: This nationwide quality improvement initiative was associated with reduced preoperative delay and improved perioperative monitoring in patients with PPU. A non-significant improvement was seen in 30-day mortality.