Predictors of Morbidity and Mortality in Esophageal Perforation: Retrospective Study of 80 Patients
| Autor: | T. Jungbluth, Hans-Peter Bruch, Erik Schloericke, Markus Zimmermann, Tobias Keck, Martin Hoffmann |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Perforation (oil well) Disease Conservative Treatment Risk Assessment Cohort Studies Hospitals University 03 medical and health sciences Postoperative Complications 0302 clinical medicine Predictive Value of Tests Cause of Death medicine Humans Minimally Invasive Surgical Procedures Emergency Treatment Aged Retrospective Studies Esophageal Perforation business.industry Anastomosis Surgical Retrospective cohort study Length of Stay Middle Aged Surgery Esophagectomy Survival Rate Treatment Outcome 030220 oncology & carcinogenesis Female Stents 030211 gastroenterology & hepatology Tomography X-Ray Computed business Time to diagnosis |
| Zdroj: | Scandinavian Journal of Surgery. 106:126-132 |
| ISSN: | 1799-7267 1457-4969 |
| DOI: | 10.1177/1457496916654097 |
| Popis: | Background and Aims: Esophageal perforation is a life-threatening disease. Factors impacting morbidity and mortality include the cause and site of the perforation, the time to diagnosis, and the therapeutic procedure. This study aimed to identify risk factors for morbidity and mortality after esophageal perforation. Patients and Methods: This retrospective study analyzed data collected from all patients treated for esophageal perforation at the Department of Surgery, University of Schleswig–Holstein, Luebeck Campus, from January 1986 through December 2011. Results: Altogether, 80 patients (52 men, 28 women; mean age 65 years) were treated. The cause of perforation was intraluminal in 44 (55%) (group A) and extraluminal in 2 (3%) (group B). Spontaneous perforations were observed in 12 (15%) (group C). Perforations were due to a preexisting esophageal disease in 22 (28%) (group D). The survival rate was higher for group A (82%) than for groups B (50%), C (57%), and D (59%). The distal third of the esophagus had the highest prevalence of perforations (49, 61%) independent of the cause. Mortality, however, was independent of the perforation site. Perforations were diagnosed within 24 h in 57% (n = 46) of patients, associated with a statistically significant lower mortality rate (p = 0.035). Altogether, 40 patients underwent non-operative treatment, and among those 27 had endoscopic treatment. Emergency thoracic surgery was performed in 40 patients: direct suture of the defect (n = 26), partial esophageal resection (n = 11), other (n = 3). Significantly higher morbidity (p = 0.007) and prolonged hospitalization (p Conclusion: Intraluminal perforations, rapid initiation of therapy, and non-operative treatment were associated with favorable outcomes. The perforation site did not have an impact on outcomes. Esophageal resection was associated with high mortality. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|