Michael Schweigert1, Hugo Santos Sousa2, Norbert Solymosi3, Aleksandar Yankulov4, Marta Jiménez Fernández5, Rory Beattie6, Attila Dubecz7, Charlotte Rabl8, Simon Law9, Daniel Tong10, Danail Petrov11, Annemaria Schäbitz12, Rudolf J Stadlhuber8, Julia Gumpp11, Dietmar Ofner8, Jim McGuigan6, José Costa-Maia2, Helmut Witzigmann12, Hubert J Stein7. 1. Department of General and Thoracic Surgery, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany. Electronic address: Schweigert-Mi@khdf.de. 2. Hospital São João, Porto, Portugal. 3. Szent István University, Budapest, Hungary. 4. University Hospital St George, Medical University of Plovdiv, Plovdiv, Bulgaria. 5. Hospital Universitario de la Princesa, Madrid, Spain. 6. Royal Victoria Hospital, Belfast, United Kingdom. 7. Klinikum Nuremberg, Nuremberg, Germany. 8. Salzburger Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria. 9. The University of Hong Kong, Hong Kong, Hong Kong. 10. St Sophia University Hospital for Pulmonary Diseases, Medical University, Sofia, Bulgaria. 11. Klinikum Neumarkt, Neumarkt in der Oberpfalz, Germany. 12. Department of General and Thoracic Surgery, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany.
Abstract
OBJECTIVE: The Pittsburgh group has suggested a perforation severity score (PSS) for better decision making in the management of esophageal perforation. Our study aim was to determine whether the PSS can be used to stratify patients with esophageal perforation into distinct subgroups with differential outcomes in an independent study population. METHODS: In a retrospective study cases of esophageal perforation were collected (study-period, 1990-2014). The PSS was analyzed using logistic regression as a continuous variable and stratified into low, intermediate, and high score groups. RESULTS: Data for 288 patients (mean age, 59.9 years) presenting with esophageal perforation (during the period 1990-2014) were abstracted. Etiology was spontaneous (Boerhaave; n = 119), iatrogenic (instrumentation; n = 85), and traumatic perforation (n = 84). Forty-three patients had coexisting esophageal cancer. The mean PSS was 5.82, and was significantly higher in patients with fatal outcome (n = 57; 19.8%; mean PSS, 9.79 vs 4.84; P < .001). Mean PSS was also significantly higher in patients receiving operative management (n = 200; 69%; mean PSS, 6.44 vs 4.40; P < .001). Using the Pittsburgh strata, patients were assigned to low PSS (≤2; n = 63), intermediate PSS (3-5; n = 86), and high PSS (>5; n = 120) groups. Perforation-related morbidity, length of stay, frequency of operative treatment, and mortality increased with increasing PSS strata. Patients with high PSS were 3.37 times more likely to have operative management compared with low PSS. CONCLUSIONS: The Pittsburgh PSS reliably reflects the seriousness of esophageal perforation and stratifies patients into low-, intermediate-, and high-risk groups with differential morbidity and mortality outcomes.
OBJECTIVE: The Pittsburgh group has suggested a perforation severity score (PSS) for better decision making in the management of esophageal perforation. Our study aim was to determine whether the PSS can be used to stratify patients with esophageal perforation into distinct subgroups with differential outcomes in an independent study population. METHODS: In a retrospective study cases of esophageal perforation were collected (study-period, 1990-2014). The PSS was analyzed using logistic regression as a continuous variable and stratified into low, intermediate, and high score groups. RESULTS: Data for 288 patients (mean age, 59.9 years) presenting with esophageal perforation (during the period 1990-2014) were abstracted. Etiology was spontaneous (Boerhaave; n = 119), iatrogenic (instrumentation; n = 85), and traumatic perforation (n = 84). Forty-three patients had coexisting esophageal cancer. The mean PSS was 5.82, and was significantly higher in patients with fatal outcome (n = 57; 19.8%; mean PSS, 9.79 vs 4.84; P < .001). Mean PSS was also significantly higher in patients receiving operative management (n = 200; 69%; mean PSS, 6.44 vs 4.40; P < .001). Using the Pittsburgh strata, patients were assigned to low PSS (≤2; n = 63), intermediate PSS (3-5; n = 86), and high PSS (>5; n = 120) groups. Perforation-related morbidity, length of stay, frequency of operative treatment, and mortality increased with increasing PSS strata. Patients with high PSS were 3.37 times more likely to have operative management compared with low PSS. CONCLUSIONS: The Pittsburgh PSS reliably reflects the seriousness of esophageal perforation and stratifies patients into low-, intermediate-, and high-risk groups with differential morbidity and mortality outcomes.
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Authors: Mircea Chirica; Michael D Kelly; Stefano Siboni; Alberto Aiolfi; Carlo Galdino Riva; Emanuele Asti; Davide Ferrari; Ari Leppäniemi; Richard P G Ten Broek; Pierre Yves Brichon; Yoram Kluger; Gustavo Pereira Fraga; Gil Frey; Nelson Adami Andreollo; Federico Coccolini; Cristina Frattini; Ernest E Moore; Osvaldo Chiara; Salomone Di Saverio; Massimo Sartelli; Dieter Weber; Luca Ansaloni; Walter Biffl; Helene Corte; Imtaz Wani; Gianluca Baiocchi; Pierre Cattan; Fausto Catena; Luigi Bonavina Journal: World J Emerg Surg Date: 2019-05-31 Impact factor: 5.469