A Nationwide Rise in the Use of Stents for Benign Esophageal Perforation
| Autor: | Aaron M. Cheng, Michael S. Mulligan, Hao He, Douglas E. Wood, Brant K. Oelschlager, Michael D. Saunders, David R. Flum, Farhood Farjah, Lucas W. Thornblade |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Fistula medicine.medical_treatment Perforation (oil well) Population 030204 cardiovascular system & hematology Rate ratio Article 03 medical and health sciences Esophagus 0302 clinical medicine medicine Humans education Digestive System Surgical Procedures Retrospective Studies education.field_of_study Esophageal Perforation business.industry Standard treatment Stent Retrospective cohort study Middle Aged medicine.disease United States Surgery medicine.anatomical_structure Female Stents 030211 gastroenterology & hepatology Esophagoscopy Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 104:227-233 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2017.03.069 |
| Popis: | Surgical repair or drainage is the standard treatment for benign esophageal perforation. The United States Food and Drug Administration has approved the use of esophageal stents for the management of malignant esophageal stricture or fistula, or both. We hypothesize that increasing enthusiasm and experience with esophageal stents has led to greater use of stents for the management of benign esophageal perforation.We performed a retrospective cohort study (2007 to 2014) of patients with benign esophageal perforation using MarketScan (Thomson Reuters, New York, NY), a commercial claims database. Patients had 6 months of follow-up. Regression was used for risk-adjustment.Benign esophageal perforation was treated in 659 patients (mean age, 49 years; 41% women), comprising surgical repair in 449 (69%), surgical drainage in 110 (17%), and stent in 100 (15%). Stent use increased from 7% in 2007 to 30% in 2014 (p0.001 for trend). Over the same period, surgical repair decreased from 71% to 53% (p = 0.001 for trend), but surgical drainage did not change (p = 0.24). After adjustment for other factors that could vary over time, stent use increased by 28% per year (incidence rate ratio, 1.28; 95% confidence interval, 1.17 to 1.39). Changes in risk-adjusted deaths, discharges home, readmissions, or costs over the same period were not significant (all p0.05 for trend).The use of stents for the management of benign esophageal perforation has increased by over fourfold in just 8 years, but short-term outcomes have not changed over time for this population of patients. A national registry for off-label use of esophageal stents may clarify the indications for and risks and benefits of stenting benign esophageal perforations. |
| Databáze: | OpenAIRE |
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