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How to Treat Esophageal Perforations When Determinants and Predictors of Mortality Are Considered

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Abstract

Background

Published lethality rates of esophageal perforation (EP) vary depending on patient- and disease-related factors. This study was designed to evaluate how these factors impact death. Furthermore, we calculated the predictive accuracy of the Mortality Prediction Model (MPM II) and the Simplified Acute Physiology Score (SAPS II) for in-hospital death. Conclusions about treatment decisions were drawn based on our data and analysis of recent literature.

Methods

Every patient who was treated for EP at our department from December 2001 to July 2008 is included in this study. Logistic regression analyses of various risk factors, such as etiology, time interval, size, comorbidities, localization, type of treatment, and preexisting pathologies of the esophagus on death, were performed.

Results

Of the 41 patients diagnosed with EP, nine died (21%). The most important risk factor concerning death was cirrhosis of the liver (0 vs. 89% mortality; odds ratio, 208; P < 0.001). Accuracy for lethality risk prediction was calculated with MPM II and SAPS II on admission, and afterward the characteristic increase that occurred was evaluated by using receiver operator characteristic curves. Optimal results were achieved by using a characteristic SAPS II increase (AUC 0.86; P: 0.009) after the patient was admitted to the intensive care unit.

Conclusions

Our study was the first to demonstrate that a rapid or continuous increase more than 40 of the daily SAPS II clearly indicates that a high risk of death is imminent. This should be used as a reevaluation factor when choosing a treatment strategy.

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Author information

Authors and Affiliations

  1. Department of Surgery, St. Franziskus Hospital Flensburg, Waldstr. 17, 24939, Flensburg, Germany

    Andrej Udelnow & Peter Würl

  2. Department of Traumatology, Hand and Plastic Surgery, Ulm University Hospital, Steinhoevelstr. 9, 89075, Ulm, Germany

    Markus Huber-Lang

  3. Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Steinhoevelstr. 9, 89075, Ulm, Germany

    Markus Juchems

  4. Department of Anesthesiology, Ulm University Hospital, Steinhoevelstr. 9, 89075, Ulm, Germany

    Karl Träger

  5. Department of General, Visceral and Transplantation Surgery, Ulm University Hospital, Steinhoevelstr. 9, 89075, Ulm, Germany

    Doris Henne-Bruns

Authors
  1. Andrej Udelnow
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  2. Markus Huber-Lang
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  3. Markus Juchems
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  4. Karl Träger
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  5. Doris Henne-Bruns
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  6. Peter Würl
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Correspondence to Andrej Udelnow.

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Udelnow, A., Huber-Lang, M., Juchems, M. et al. How to Treat Esophageal Perforations When Determinants and Predictors of Mortality Are Considered. World J Surg 33, 787–796 (2009). https://doi.org/10.1007/s00268-008-9857-5

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  • DOI: https://doi.org/10.1007/s00268-008-9857-5

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