Unfavorable outcomes and their predictors in patients treated for perforated peptic ulcer disease in Ethiopia: systematic review and meta-analysis

Abstract

Background: Perforated peptic ulcer (PPU) is a surgical emergency condition associated with substantial mortality and morbidity. Despite scattered studies, there exists a gap in comprehensive evidence on management outcomes of this condition in Ethiopia. Hence, this review aimed to assess the pooled mortality and complication rates along with their predictors in patients treated for PPU. Methods: In this review, an extensive search across various electronic databases including PubMed, Africa Index Medicus, Science Direct, and Hinari was conducted. Additionally, searches were conducted in Google Scholar and online library repositories of Addis Ababa, Hawassa, and Bahir Dar Universities, complemented by manual searches of included studies. Data extraction was performed using Excel and the analysis was done using STATA 17 software. Pooled estimates of mortality and complication rates were determined using a random-effect model, while associated predictors were identified through the analysis using a fixed-effect model. Subgroup analysis for mortality rate was conducted by region. Sensitivity analysis was performed after assessing heterogeneity using the I2 test, and potential publication bias was examined through funnel plots, along with Egger's and Begg's tests. Results: This meta-analysis, encompassing 9 studies, revealed a pooled mortality rate of 6.68% (95% CI: 4.36, 9.00) with a high level of heterogeneity (I2 = 57%) and a complication rate of 23.21% (95% CI: 19.72, 26.69) with a moderate level of heterogeneity (I2 = 43%) in patients treated for PPU. Notably, presentation after 24 h exhibited 4 times higher odds (95% CI: 1.79–8.95) of developing complications, while low systolic blood pressure (AOR 4.81; 95% CI: 1.75–13.20) was associated with increased complication risk. Conclusion: In Ethiopia, morbidity and mortality following PPU management are significant, influenced by delayed presentation, low systolic blood pressure, and advanced age. Timely interventions, early hemodynamic stabilization, and age-specific considerations are vital to improving outcomes. Protocol registration number: CRD42024497946.