Current Thoracic Surgery 2024 , Vol 9 , Issue 2
Factors affecting mortality in esophageal perforation
Gökhan Kocaman1,Yusuf Kahya1,Murat Özkan1,Bülent Mustafa Yenigün1
1Department of Thoracic Surgery, Ankara University, Faculty of Medicine, Ankara, Turkey DOI : 10.26663/cts.2024.014 Viewed : 786 - Downloaded : 211 Background: Esophageal perforation have high mortality. Due to its relative rarity and lack of clinical experience, there are no established guidelines for its treatment. Abbas and colleagues developed a perforation severity score (PSS) in 2009, using the patient's clinical parameters at the time of diagnosis for predicting prognosis of the patient. We aimed to identify the prognostic factors affecting mortality for patients with esophageal perforation including PSS.

Materials and Methods: The records of 21 patients with esophageal perforation between 2010 and 2023 were examined retrospectively. The age, gender, Charlson Comorbidity Index, etiology, time to diagnosis, extent of perforation (contained/non-contained), localization, operation and PSS of the patients were recorded and their relationship with mortality was analyzed.

Results: Nine (42.9%) patients were female and the median age was 56 (19-73 years). Cervical perforations were seen in 13 (61.9%) patients and 8 (38.1%) patients had thoracic perforations. Median time to diagnosis was 2 days (1-30 days). Median PSS for non-operative patients was 2 and ıt was 6 for operative patients (p = 0.086). Mortality rate was 19% (4 patients). Patients are grouped according to mortality. Age, sex distribution, comorbidity index, etiology, perforation localization, time to diagnosis, management strategy and PSS between groups were compared. Only localization has statistically significant difference between groups (p = 0.01).

Conclusions: Optimum therapy should be chosen according to patients’ comorbidities, etiology, perforation localization, extent of perforation, time to diagnosis and medical status of the patient. Patients with low-risk score and who have a contained leak could be treated with non-operative therapies Keywords : esophageal perforation, perforation severity score, surgery, prognosis, mortality