EVALUATION OF OUTCOMES FOLLOWING PERFORATED DUODENAL ULCER USING BOEY SCORE

Abstract

BACKGROUND: Peptic ulcer disease (PUD) results from acid-induced injury to the upper gastrointestinal tract, particularly the stomach and duodenum. The American Gastroenterological Association estimates a prevalence of 10–20% among individuals with upper gastrointestinal symptoms. The primary etiological factors include Helicobacter pylori infection and non-steroidal anti-inflammatory drug (NSAID) use. Perforation remains a life-threatening complication of PUD, and clinical risk scores such as the Boey and PULP (Peptic Ulcer Perforation) scores are commonly utilized to predict postoperative morbidity and mortality.

OBJECTIVE: To evaluate postoperative outcomes in patients with perforated duodenal ulcers (PDU) using Boey’s score.

METHODS: This cohort study was conducted in the General Surgery Department of HMC- MTI, Peshawar. A total of 104 patients diagnosed with PDU were enrolled and divided into two groups based on Boey’s score: Exposed (score ≥1, n=52) and non-exposed (score 0, n=52). Patient demographics, comorbidities, operative details, and postoperative outcomes were recorded using a structured proforma. Postoperative complications and mortality within 30 days were analyzed. The predictive performance of Boey, PULP, and ASA scores was assessed using ROC curve analysis.

RESULTS: Morbidity was significantly higher in the exposed group compared to the non-exposed group (25% vs 5.8%, p=0.006). Pulmonary complications were also significantly more frequent (11.5% vs 1.9%, p=0.049). Length of hospital stay was significantly prolonged in the exposed group (8.7 ± 2.6 vs 5.2 ± 1.8 days, p<0.001). ROC analysis demonstrated moderate discriminatory ability for PULP (AUC 0.72), Boey (AUC 0.69), and ASA (AUC 0.69) scores for predicting 30-day morbidity. The optimal cutoff for PULP was ≥3 (sensitivity 64.7%, specificity 74.6%).

CONCLUSION: A Boey score ≥1 is significantly associated with increased morbidity and prolonged hospital stay following surgery for PDU. PULP score showed higher predictive accuracy compared to Boey and ASA scores. Risk stratification using these tools may help optimize perioperative care and improve outcomes in PDU patients.