A multifactorial analysis of mortality and morbidity in perforated peptic ulcer disease. Perforated peptic ulcer disease remains a source of considerable morbidity and mortality, and the suggested methods of surgical therapy are diverse. We reviewed the course of 113 patients who were treated surgically and identified 14 factors that influenced the morbidity or mortality rates, or both. Multiple regression analysis showed that the number of coexisting medical conditions, a lower mean blood pressure level and the duration of acute perforation were independent risk factors for death, while age, use of a bronchodilator, a lower mean blood pressure level and the number of coexisting medical conditions correlated positively with all complications. A duodenal site was independently favorable with respect to all complications. The type of operation performed either simple closure, vagotomy and drainage or resection, did not influence morbidity or mortality. The most severely ill patients also did not benefit from any particular type of operation in the short term. Long term results were improved with definitive operation, as measured by the Visick classification and the need for reoperations. Definitive operations are recommended for virtually all patients with perforated peptic ulcer. 