Postoperative outcomes in perforated duodenal ulcer: comparative predictive performance of Boey and Pulp scores

Abstract

Introduction: Perforation remains a life-threatening complication of Peptic ulcer disease (PUD), and clinical risk scores such as the Boey and PULP (Peptic Ulcer Perforation) scores are commonly utilized to predict postoperative morbidity and mortality.

Objectives: To evaluate the predictive outcome of the Boey score in determining morbidity outcomes among patients with perforated duodenal ulcer and to compare its performance with the PULP scoring system.

Materials and Methods: This prospective diagnostic accuracy study was conducted in the General Surgery Department of Khyber Teaching Hospital, MTI, Peshawar Pakistan. A total of 104 patients diagnosed with PDU were divided into two groups using the Boey score: Index test (score ≥1, n=52) and Reference standard (score 0, n=52). A structured proforma was used to record patient demographics, comorbidities, operative details, and postoperative outcomes. Postoperative complications and mortality within 30 days were analyzed. The predictive performance of Boey and PULP scores was assessed using ROC curve analysis.

Results: Morbidity was higher (25% vs 5.8%, p=0.006), pulmonary complications more frequent (11.5% vs 1.9%, p=0.049) and length of hospital stay significantly prolonged (8.7 ± 2.6 vs 5.2 ± 1.8 days, p<0.001) in the Index test group compared to the Reference standard group. ROC analysis demonstrated moderate discriminatory ability for PULP (AUC 0.74) and Boey (AUC 0.76) scores for predicting 30-day morbidity.

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 score.