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Surgical Management of Esophageal Perforation: Examining Trends in a Multi-Institutional Cohort

Journal of Gastrointestinal Surgery volume 27, pages 1757–1765 (2023)Cite this article

Abstract

Background

Esophageal perforations historically are associated with significant morbidity and mortality and generally require emergent intervention. The influence of improved diagnostic and therapeutic modalities available in recent years on management has not been examined. This study examined the surgical treatments and outcomes of a modern cohort.

Methods

Patients with esophageal perforation management in the 2005-2020 American College of Surgeons National Surgical Quality Improvement Program database were stratified into three eras (2005-2009, 2010-2014, and 2015-2020). Surgical management was classified as primary repair, resection, diversion, or drainage alone based on procedure codes. The distribution of procedure use, morbidity, and mortality across eras was examined.

Results

Surgical management of 378 identified patients was primary repair (n=193,51%), drainage (n=89,24%), resection (n=70,18%), and diversion (n=26,7%). Thirty-day mortality in the cohort was 9.5% (n=36/378) and 268 patients (71%) had at least one complication. The median length of stay was 15 days. Both morbidity (Era 1 65% [n=42/60] versus Era 2 69% [n=92/131] versus Era 3 72% [n=135/187], p=0.3) and mortality (Era 1 11% [n=7/65] versus Era 2 9% [n=12/131] versus Era 3 10% [n=19/187], p=0.9) did not change significantly over the three defined eras. Treatment over time evolved such that primary repair was more frequently utilized (43% in Era 1 to 51% in Era 3) while diversion was less often performed (13% in Era 1 to 7% in Era 3) (p=0.009).

Conclusions

Esophageal perforation management in recent years uses diversion less often but remains associated with significant morbidity and mortality.

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Acknowledgments

American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, California, USA

    Lye-Yeng Wong, Matthew Leipzig, Douglas Z. Liou, Leah M. Backhus, Natalie S. Lui, Joseph B. Shrager & Mark F. Berry

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  1. Lye-Yeng Wong
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Correspondence to Lye-Yeng Wong.

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The authors have no conflicts of interest or funding sources related to this manuscript. All listed authors contributed substantially to the design, drafting, approval, and accountability of this work. Word count: 4,737

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This project has been presented as a poster at the General Thoracic Surgical Club’s 34th Annual Meeting, Bonita Springs, FL, March 10-13, 2022

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Wong, LY., Leipzig, M., Liou, D.Z. et al. Surgical Management of Esophageal Perforation: Examining Trends in a Multi-Institutional Cohort. J Gastrointest Surg 27, 1757–1765 (2023). https://doi.org/10.1007/s11605-023-05700-1

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