Abstract

Background

Time of diagnosis (TOD) of benign esophageal perforation is regarded as an important risk factor for clinical outcome, although convincing evidence is lacking. The aim of this study is to assess whether time between onset of perforation and diagnosis is associated with clinical outcome in patients with iatrogenic esophageal perforation (IEP) and Boerhaave’s syndrome (BS).

Methods

We searched MEDLINE, Embase and Cochrane library through June 2018 to identify studies. Authors were invited to share individual patient data and a meta-analysis was performed (PROSPERO: CRD42018093473). Patients were subdivided in early (≤ 24 h) and late (> 24 h) TOD and compared with mixed effects multivariable analysis while adjusting age, gender, location of perforation, initial treatment and center. Primary outcome was overall mortality. Secondary outcomes were length of hospital stay, re-interventions and ICU admission.

Results

Our meta-analysis included IPD of 25 studies including 576 patients with IEP and 384 with BS. In IEP, early TOD was not associated with overall mortality (8% vs. 13%, OR 2.1, 95% CI 0.8–5.1), but was associated with a 23% decrease in ICU admissions (46% vs. 69%, OR 3.0, 95% CI 1.2–7.2), a 22% decrease in re-interventions (23% vs. 45%, OR 2.8, 95% CI 1.2–6.7) and a 36% decrease in length of hospital stay (14 vs. 22 days, p < 0.001), compared with late TOD. In BS, no associations between TOD and outcomes were found. When combining IEP and BS, early TOD was associated with a 6% decrease in overall mortality (10% vs. 16%, OR 2.1, 95% CI 1.1–3.9), a 19% decrease in re-interventions (26% vs. 45%, OR 1.9, 95% CI 1.1–3.2) and a 35% decrease in mean length of hospital stay (16 vs. 22 days, p = 0.001), compared with late TOD.

Conclusions

This individual patient data meta-analysis confirms the general opinion that an early (≤ 24 h) compared to a late diagnosis (> 24 h) in benign esophageal perforations, particularly in IEP, is associated with improved clinical outcome.

Details

Title
Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta-analysis
Author
Vermeulen, Bram D 1   VIAFID ORCID Logo  ; van der Leeden Britt 2 ; Ali, Jawad T 3 ; Gudbjartsson Tomas 4 ; Hermansson, Michael 5 ; Low, Donald E 6 ; Adler, Douglas G 7 ; Botha, Abraham J 8 ; D’Journo Xavier B 9 ; Eroglu Atila 10 ; Ferri, Lorenzo E 11 ; Gubler Christoph 12 ; Haveman, Jan Willem 13 ; Kaman Lileswar 13 ; Kozarek, Richard A 14 ; Law, Simon 15 ; Loske Gunnar 16 ; Lindenmann Joerg 17 ; Jung-Hoon, Park 18 ; David, Richardson J 19 ; Salminen Paulina 20 ; Ho-Yong, Song 18 ; Søreide, Jon A 21 ; Spaander Manon C W 22 ; Tarascio, Jeffrey N 23 ; Tsai, Jon A 24 ; Vanuytsel Tim 25 ; Rosman Camiel 26 ; Siersema, Peter D 2 ; van der Bogt Ruben D 23 ; Birch, Madeleine 7 ; Dubose, Joseph J 3 ; Fox, Sam 24 ; Jaklitsch, Michael T 24 ; Kuppusamy, Madhan K 6 ; Persson Saga 24 ; Rice, Robert D 3 ; Smolle Josef 17 ; Smolle-Juettner Freyja M 17 ; Sudarshan Monisha 11 ; Sutcliffe, Robert P 27 ; Vidarsdottir Halla 4 ; Viste Asgaut 28 

1  Radboud University Medical Center, Department of Gastroenterology and Hepatology, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382); Radboud University Medical Center, Department of Gastroenterology and Hepatology (Route 455), Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382) 
2  Radboud University Medical Center, Department of Gastroenterology and Hepatology, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382) 
3  University of Texas at Austin, Dell Medical School, Department of General Surgery, Texas, USA (GRID:grid.89336.37) (ISNI:0000 0004 1936 9924) 
4  Landspitali University Hospital, Department of Cardiothoracic Surgery, Reykjavik, Iceland (GRID:grid.410540.4) (ISNI:0000 0000 9894 0842) 
5  Skane University Hospital, Department of Upper GI Surgery, Lund, Sweden (GRID:grid.411843.b) (ISNI:0000 0004 0623 9987) 
6  Virginia Mason Medical Center, Department of Thoracic Surgery and Thoracic Oncology, Seattle, USA (GRID:grid.416879.5) (ISNI:0000 0001 2219 0587) 
7  University of Utah School of Medicine, Department of Medicine, Gastroenterology and Hepatology, Salt Lake City, USA (GRID:grid.223827.e) (ISNI:0000 0001 2193 0096) 
8  Guy’s & St Thomas’s Hospitals, Department of General and GI Surgery, London, UK (GRID:grid.223827.e) 
9  Aix-Marseille Université, North Hospital, Department of Thoracic Surgery, Marseille, France (GRID:grid.223827.e) 
10  Ataturk University, Department of Thoracic Surgery, Medical Faculty, Erzurum, Turkey (GRID:grid.411445.1) (ISNI:0000 0001 0775 759X) 
11  McGill University, Montreal General Hospital, Department of Surgery and Oncology, Montreal, Canada (GRID:grid.14709.3b) (ISNI:0000 0004 1936 8649) 
12  Universitäts Spital Zürich, Klinik für Gastroenterologie und Hepatologie, Zurich, Switzerland (GRID:grid.412004.3) (ISNI:0000 0004 0478 9977) 
13  University Medical Center Groningen, University of Groningen, Department of Surgery, Groningen, The Netherlands (GRID:grid.4830.f) (ISNI:0000 0004 0407 1981) 
14  Virginia Mason Medical Center, Digestive Disease Institute, Seattle, USA (GRID:grid.416879.5) (ISNI:0000 0001 2219 0587) 
15  University of Hong Kong, Department of Surgery, Pok Fu Lam, Hong Kong (GRID:grid.194645.b) (ISNI:0000000121742757) 
16  Katholisches Marienkrankenhaus Hamburg gGmbH, Department for General, Abdominal, Thoracic and Vascular Surgery, Hamburg, Germany (GRID:grid.491928.f) (ISNI:0000 0004 0390 3635) 
17  Medical University of Graz, Division of Thoracic Surgery and Hyperbaric Surgery, Graz, Austria (GRID:grid.11598.34) (ISNI:0000 0000 8988 2476) 
18  University of Ulsan College of Medicine, Department of Vascular and Interventional Radiology, Asan Medical Center, Seoul, Republic of Korea (GRID:grid.267370.7) (ISNI:0000 0004 0533 4667) 
19  University of Louisville School of Medicine, Department of Surgery, Louisville, USA (GRID:grid.266623.5) (ISNI:0000 0001 2113 1622) 
20  Turku University Hospital, Division of Digestive Surgery and Urology, Turku, Finland (GRID:grid.410552.7) (ISNI:0000 0004 0628 215X) 
21  Stavanger University Hospital, Department of Gastrointestinal Surgery, Stavanger, Norway (GRID:grid.412835.9) (ISNI:0000 0004 0627 2891); University of Bergen, Department of Clinical Medicine, Bergen, Norway (GRID:grid.7914.b) (ISNI:0000 0004 1936 7443) 
22  Erasmus MC University Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, The Netherlands (GRID:grid.5645.2) (ISNI:000000040459992X) 
23  Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, USA (GRID:grid.62560.37) (ISNI:0000 0004 0378 8294) 
24  Karolinska Institutet, CLINTEC, Division of Surgery, Stockholm, Sweden (GRID:grid.4714.6) (ISNI:0000 0004 1937 0626) 
25  Translational Research Center for Gastrointestinal, KU Leuven, Department of Chronic Diseases, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884) 
26  Radboud University Medical Center, Department of Surgery, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382) 
27  Guy’s & St Thomas’s Hospitals, Department of General and GI Surgery, London, UK (GRID:grid.14709.3b) 
28  University of Bergen, Department of Clinical Medicine, Bergen, Norway (GRID:grid.7914.b) (ISNI:0000 0004 1936 7443); Erasmus MC University Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, The Netherlands (GRID:grid.5645.2) (ISNI:000000040459992X) 
Pages
3492-3505
Publication year
2021
Publication date
Jul 2021
Publisher
Springer Nature B.V.
ISSN
09302794
e-ISSN
14322218
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1007/s00464-020-07806-y
ProQuest document ID
2540005738
Copyright
© The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.