Risk factors of perioperative mortality from complicated peptic ulcer disease in Africa: Systematic review and meta-analysis

Sarah Peiffer, Matthew Pelton, Laura Keeney, Eustina G. Kwon, Richard Ofosu-Okromah, Yubraj Acharya, Vernon M. Chinchilli, David I. Soybel, John S. Oh, Paddy Ssentongo*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


In 2013, peptic ulcer disease (PUD) caused over 300 000 deaths globally. Low-income and middle-income countries are disproportionately affected. However, there is limited information regarding risk factors of perioperative mortality rates in these countries. Objective To assess perioperative mortality rates from complicated PUD in Africa and associated risk factors. Design We performed a systematic review and a random-effect meta-analysis of literature describing surgical management of complicated PUD in Africa. We used subgroup analysis and meta-regression analyses to investigate sources of variations in the mortality rates and to assess the risk factors contributing to mortality. Results From 95 published reports, 10 037 patients underwent surgery for complicated PUD. The majority of the ulcers (78%) were duodenal, followed by gastric (14%). Forty-one per cent of operations were for perforation, 22% for obstruction and 9% for bleeding. The operations consisted of vagotomy (38%), primary repair (34%), resection and reconstruction (12%), and drainage procedures (6%). The overall PUD mortality rate was 6.6% (95% CI 5.4% to 8.1%). It increased to 9.7% (95% CI 7.1 to 13.0) when we limited the analysis to studies published after the year 2000. The correlation was higher between perforated PUD and mortality rates (r=0.41, p<0.0001) than for bleeding PUD and mortality rates (r=0.32, p=0.001). Non-significant differences in mortality rates existed between sub-Saharan Africa (SSA) and North Africa and within SSA. Conclusion Perioperative mortality rates from complicated PUD in Africa are substantially high and could be increasing over time, and there are possible regional differences.

Original languageEnglish
Article numbere000350
JournalBMJ Open Gastroenterology
Issue number1
StatePublished - 17 Feb 2020
Externally publishedYes


  • Africa
  • bleeding
  • obstruction
  • peptic ulcer disease
  • perforation


Dive into the research topics of 'Risk factors of perioperative mortality from complicated peptic ulcer disease in Africa: Systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this