Twenty-one patients had surgery for peptic ulcer perforation in the general surgery clinics of three hospitals between August 6, 2022, and February 6, 2023, before the earthquake. The number of patients between February 6, 2023, and August 6, 2023, 6 months after the earthquake, was determined to be 45. The study included 66 patients who met the study criteria.
One (5%) female patient underwent surgery before the earthquake, and 20 (95%) patients were male. Nine (20%) of the patients operated on after the earthquake were women, and 36 (80%) were men. Two (10%) patients who underwent surgery before the earthquake and two (4%) patients who underwent surgery after the earthquake died.
The average age of the 21 patients who underwent surgery before the earthquake was 41.62 (±16.15), the average length of stay was 5.81 (±1.89) days, the average diameter of the perforation was 5.62 (±2.06) mm, and the average duration of the surgery was 57 months. It was determined to be 57.86 (±9.43) min. The following parameters were observed in 45 patients after the earthquake: mean age, 45.36 (±16.36) yr; mean length of stay, 5.64 (±1.25) days; mean perforation diameter, 5.24 (±2.33) mm; and mean duration, 59.11 (±13.79) min. The operation time was determined (Table 1).
Perforation was prepyloric in 13 (62%) and postpyloric in eight (38%) patients before the earthquake. It was prepyloric in 23 (51%) and postpyloric in 22 (49%) patients after the earthquake. It was located postpyloric. Prepyloric ones were in the antrum, whereas postpyloric ones were in the bulbous.
In laboratory findings, before the earthquake, the average serum albumin level was 3.95 (±0.41) g/dL, the average urea level was 32 (±30.93) mg/dL, the average creatinine level was 1.0 (±0.64) mg/dL, the average hemoglobin level was 14.7 (±1.21) g/dL, and the average WBC level was 12,976 (±4,078) 10e3/µL. After the earthquake, the average serum albumin level was 4.01 (±0.56) g/dL, the average urea level was 35.07 (±23.28) mg/dL, the average creatinine level was 0.97 (±0.51) mg/dL, the average hemoglobin level was 13.84 (±2.18) g/dL, and the average WBC level was 12,851 (±4,214) 10e3/µL (Table 1).
Table 1. Laboratory parameters and other findings of surgical patients
Parameters
|
Perforation time
|
p value
|
Before the earthquake (n1 = 21)
|
After the earthquake (n2 = 45)
|
Min
|
Max
|
|
Min
|
Max
|
|
Age
|
19
|
72
|
41.62 ± 16.15
|
18
|
76
|
45.36 ±
|
0.91
|
Length of stay
|
1
|
8
|
5.81 ± 1.89
|
3
|
9
|
5.64 ± 1.25
|
0.58
|
Diameter
|
3
|
10
|
5.62 ± 2.06
|
2
|
10
|
5.24 ± 2.33
|
0.40
|
Operation time
|
30
|
70
|
57.86 ± 9.43
|
40
|
90
|
59.11 ± 13.79
|
0.78
|
Albumin
|
3.1
|
4.6
|
3.95 ± 0.41
|
2.7
|
5.1
|
4.01 ± 0.56
|
0.20
|
Urea
|
12
|
121
|
32 ± 30.93
|
10
|
115
|
35.07 ± 23.28
|
0.14
|
Creatinine
|
0.6
|
3.4
|
1.0 ± 0.64
|
0.5
|
3.7
|
0.97 ± 0.51
|
0.51
|
Hemoglobin
|
11.9
|
16.6
|
14.7 ± 1.21
|
7.3
|
18.4
|
13.84 ± 2.18
|
0.07
|
WBC
|
3,200
|
19,900
|
12,976 ± 4,078
|
4,100
|
27,800
|
12,851 ± 4,214
|
0.73
|
Note. WBC, white blood cell.
When the patients were evaluated in terms of comorbid diseases, four patients had coronary artery disease, four patients had congestive heart failure, and eight patients had diabetes mellitus. Two of the patients had previously undergone colon resections for colon cancer, and one underwent a laparotomy–bridectomy for ileus. No intraoperative biopsy was performed on patients from the perforation area. All patients underwent postoperative elective gastroscopy and gastric biopsy.
Statistical analysis revealed no significant differences in the parameters evaluated before and after the earthquake, including age, length of stay, perforation area diameter, surgery times, and laboratory parameters examined (Table 1).
Table 2. Chi-square test values for perforation time and number of surgical patients
Perforation time
|
Number of surgical patients
|
p
|
Before the earthquake
|
21
|
0.003
|
After the earthquake
|
45
|
The Chi-square goodness-of-fit test was used to determine whether the proportion of patients operated on for perforation was equal before and after the earthquake. The rates showed statistically significant differences depending on the earthquake, χ2 (1, N = 66) = 8.73, p = 0.003 (Table 2).