COVID-19 related stress and the risk of perforated peptic ulcer: a cross-sectional study

Introduction: Perforated peptic ulcer (PPU) is the fatal complication of peptic ulcer disease and is associated with increased morbidity and mortality of patients. Psychological stress significantly increases the risk of developing PPU. This coronavirus disease 2019 (COVID-19) pandemic causes fear and uncertainty, increasing psychological stress and perceived stress. This study aims to analyze the effect of COVID-19 pandemic high psychological stress as a risk factor for developing PPU. Methods: A cross-sectional study was conducted on all adult patients diagnosed and that underwent surgery for PPU from July 2017 to March 2021. The nonpandemic group consists of patients who underwent PPU surgery from July 2017 to February 2020 and the pandemic group from March 2020 to March 2021. Perceived stress is collected from the patient during the follow-up visit using an Indonesian version of the Perceived Stress Scale (PSS-10) questionnaire. Results: A total of 53 patients with PPU underwent surgery in our hospital. Twenty-five patients from the nonpandemic period and 28 patients during the pandemic period. There was a significant increase in postoperative complication or morbidity rate (78.5% vs. 52%; prevalence ratio: 1.51, 95% confidence interval: 0.99–2.31; P =0.041) in pandemic group. Stress level were also higher in the pandemic group compared with the nonpandemic group (42.1% vs. 5.6%; prevalence ratio: 7.58; 95% confidence interval: 1.05–54.69; P =0.006). Conclusions: COVID-19 pandemic impacts psychological stress, consequently increasing the risk of PPU and increasing morbidity.