Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta-analysis

Research output: Contribution to journalArticle

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

Authors
  • Bram D. Vermeulen
  • Britt van der Leeden
  • Jawad T. Ali
  • Tomas Gudbjartsson
  • Michael Hermansson
  • Donald E. Low
  • Douglas G. Adler
  • Abraham J. Botha
  • Xavier B. D’Journo
  • Atila Eroglu
  • Lorenzo E. Ferri
  • Christoph Gubler
  • Jan Willem Haveman
  • Lileswar Kaman
  • Richard A. Kozarek
  • Simon Law
  • Gunnar Loske
  • Joerg Lindenmann
  • Jung Hoon Park
  • J. David Richardson
  • Paulina Salminen
  • Ho Yong Song
  • Jon A. Søreide
  • Manon C.W. Spaander
  • Jeffrey N. Tarascio
  • Jon A. Tsai
  • Tim Vanuytsel
  • Camiel Rosman
  • Peter D. Siersema
  • the Benign Esophageal Perforation Collaborative Group
Organisations
External organisations
  • Radboud University Medical Center
  • National University Hospital of Iceland
  • Skåne University Hospital
  • Virginia Mason Medical Center
  • University of Utah
  • Guy's and St Thomas' NHS Foundation Trust
  • Aix-Marseille University
  • Atatürk University
  • Montreal General Hospital
  • University Hospital of Zurich
  • University Medical Center Groningen
  • University of Hong Kong
  • Medical University of Graz
  • University of Ulsan
  • Turku University Hospital
  • Stavanger University Hospital
  • University of Bergen
  • Erasmus University Medical Center
  • Brigham and Women's Hospital, Boston
  • Karolinska Institutet
  • Catholic University of Leuven
  • University of Texas at Austin
  • Hopital Nord AP-HM
  • McGill University
  • University of Groningen
  • Marienkrankenhaus Hamburg
  • University of Louisville
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Gastroenterology and Hepatology

Keywords

  • Esophageal rupture, Individual patient data meta-analysis, Time of diagnosis
Original languageEnglish
JournalSurgical Endoscopy
Publication statusE-pub ahead of print - 2020 Dec 17
Publication categoryResearch
Peer-reviewedYes