TY - JOUR
T1 - Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation
T2 - an individual patient data meta-analysis
AU - the Benign Esophageal Perforation Collaborative Group
AU - Vermeulen, Bram D.
AU - van der Leeden, Britt
AU - Ali, Jawad T.
AU - Guðbjartsson, Tómas
AU - Hermansson, Michael
AU - Low, Donald E.
AU - Adler, Douglas G.
AU - Botha, Abraham J.
AU - D’Journo, Xavier B.
AU - Eroglu, Atila
AU - Ferri, Lorenzo E.
AU - Gubler, Christoph
AU - Haveman, Jan Willem
AU - Kaman, Lileswar
AU - Kozarek, Richard A.
AU - Law, Simon
AU - Loske, Gunnar
AU - Lindenmann, Joerg
AU - Park, Jung Hoon
AU - Richardson, J. David
AU - Salminen, Paulina
AU - Song, Ho Yong
AU - Søreide, Jon A.
AU - Spaander, Manon C.W.
AU - Tarascio, Jeffrey N.
AU - Tsai, Jon A.
AU - Vanuytsel, Tim
AU - Rosman, Camiel
AU - Siersema, Peter D.
AU - van der Bogt, Ruben D.
AU - Birch, Madeleine
AU - Dubose, Joseph J.
AU - Fox, Sam
AU - Jaklitsch, Michael T.
AU - Kuppusamy, Madhan K.
AU - Persson, Saga
AU - Rice, Robert D.
AU - Smolle, Josef
AU - Smolle-Juettner, Freyja M.
AU - Sudarshan, Monisha
AU - Sutcliffe, Robert P.
AU - Vidarsdottir, Halla
AU - Viste, Asgaut
N1 - Publisher Copyright: © 2020, The Author(s). No funding was acquired for this study.
PY - 2020/7/17
Y1 - 2020/7/17
N2 - 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.
AB - 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.
KW - Early Diagnosis
KW - Esophageal Perforation/diagnosis
KW - Esophageal rupture
KW - Humans
KW - Individual patient data meta-analysis
KW - Length of Stay
KW - Mediastinal Diseases
KW - Risk Factors
KW - Time of diagnosis
UR - http://www.scopus.com/inward/record.url?scp=85087960628&partnerID=8YFLogxK
U2 - 10.1007/s00464-020-07806-y
DO - 10.1007/s00464-020-07806-y
M3 - Article
C2 - 32681374
SN - 0930-2794
VL - 35
SP - 3492
EP - 3505
JO - Surgical Endoscopy
JF - Surgical Endoscopy
IS - 7
ER -