Comparative Discrimination of Boey, PULP, and PPUMSs for Textbook Outcome Failure, Failure-to-Rescue, and 30-Day Mortality Following Perforated Peptic Ulcer Surgery

Background and Objectives: Early Textbook Outcome (Early TO), defined via the Naumann/BEACON Delphi process for non-traumatic emergency laparotomy, and Failure-to-Rescue (FTR) provide postoperative outcome frameworks beyond overall mortality. This study compared the discriminative performance of the mortality-oriented Boey, Peptic Ulcer Perforation (PULP), and Perforated Peptic Ulcer Mortality Score (PPUMS) scores for Early TO failure, FTR, and 30-day mortality in perforated peptic ulcer surgery. Materials and Methods: This retrospective, single-center cohort study included 128 consecutive adults undergoing emergency surgery for gastroduodenal peptic ulcer perforation (January 2015–February 2026). Boey, PULP, and PPUMSs were calculated from preoperative data. The primary outcome was Early TO failure (Naumann/BEACON criteria); secondary outcomes were FTR and 30-day mortality. FTR was assessed among patients with a documented Clavien–Dindo grade III/IV complication. Discriminative performance was quantified as the area under the receiver operating characteristic curve (AUC); correlated AUCs were compared using paired DeLong tests, with Holm adjustment for multiple comparisons within each outcome.