Ramadan fasting is associated with reduced penetrating trauma and increased peptic ulcer perforation: a 10-year retrospective analysis.

Abstract

Background: Ramadan fasting alters neuroendocrine rhythms, nocturnal gastric acid secretion, and population-level social behaviour. Its concurrent impact on acute gastrointestinal complications and on community-level violent trauma in high-volume urban settings remains poorly quantified.

Objectives: To evaluate the impact of Ramadan fasting on the frequency of surgical admissions for penetrating trauma, blunt trauma, peptic ulcer perforation (PUP), and acute appendicitis over a 10-year period.

Design: Retrospective chart review.

Settings: İstanbul Bağcılar Training and Research Hospital, University of Health Sciences Türkiye (Tertiary Academic Referral Hospital).

Materials and methods: Emergency admissions requiring surgical intervention between 2016 and 2025 were reviewed. Ramadan periods were compared with equivalent non-Ramadan periods using Poisson regression with robust standard errors, reporting incidence rate ratios (IRR) with 95% confidence intervals. Matched calendar-month, ±30-day adjacent-window, and season-stratified sensitivity analyses were performed. Bonferroni-adjusted P values are also reported; primary conclusions are based on uncorrected values (threshold P<.05).

Main outcome measures: Comparative frequencies of penetrating trauma and PUP admissions during Ramadan versus non-Ramadan periods; secondary outcomes were blunt trauma and acute appendicitis admissions.

Sample size: 20 968 emergency cases meeting the inclusion criteria (12 162 males, 8806 females).

Results: Cases comprised 1549 penetrating trauma, 3619 blunt trauma, 776 PUP, and 2920 acute appendicitis. Penetrating trauma admissions were significantly lower during Ramadan [9.7 (2.8) vs 13.2 (2.6) cases per month; IRR 0.73, 95% CI 0.58-0.93; P=.049], predominantly among males (P=.021) and during evening and early morning hours. PUP admissions were significantly higher during Ramadan [10.5 (4.6) vs 6.1 (2.3); IRR 1.72, 95% CI 1.24-2.39; P=.041], particularly in males (P=.048), peaking in the early morning. A significant pandemic-period interaction was identified for PUP [P=.031 (interaction test)], the excess being larger in 2022-2025. No significant differences were observed for blunt trauma [26.4 (3.2) vs 30.5 (3.1); P=.201] or acute appendicitis [22.5 (3.1) vs 24.5 (3.0); P=.392].

Conclusion: Ramadan fasting is associated with a reduced admission frequency of penetrating trauma and an increased admission frequency of PUP, predominantly in male patients, highlighting opportunities for targeted prevention and resource planning. Multicentre prospective studies incorporating individual fasting status are warranted.

Limitations: Single-centre design. Potential unmeasured confounders, including changes in referral patterns or the COVID-19 pandemic, cannot be excluded.