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

TitleEarly diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta-analysis
Authors
KeywordsEsophageal rupture
Individual patient data meta-analysis
Time of diagnosis
Issue Date2021
PublisherSpringer New York LLC. The Journal's web site is located at http://link.springer-ny.com/link/service/journals/00464/
Citation
Surgical Endoscopy, 2021, v. 35 n. 7, p. 3492-3505 How to Cite?
AbstractBackground: 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.
Persistent Identifierhttp://hdl.handle.net/10722/308337
ISSN
2020 Impact Factor: 4.584
2020 SCImago Journal Rankings: 1.457
PubMed Central ID

 

DC FieldValueLanguage
dc.contributor.authorVermeulen, BD-
dc.contributor.authorvan der Leeden, B-
dc.contributor.authorAli, JT-
dc.contributor.authorGudjartsson, T-
dc.contributor.authorHermansson, M-
dc.contributor.authorLow, DE-
dc.contributor.authorAdler, DG-
dc.contributor.authorBotha, AJ-
dc.contributor.authorD’Journo, XB-
dc.contributor.authorEroglu, A-
dc.contributor.authorFerri, LE-
dc.contributor.authorGubler, C-
dc.contributor.authorHaveman, JW-
dc.contributor.authorKaman, L-
dc.contributor.authorKozarek, RA-
dc.contributor.authorLaw, S-
dc.contributor.authorLoske, G-
dc.contributor.authorLindenmann, J-
dc.contributor.authorPark, JH-
dc.contributor.authorRichardson, JD-
dc.contributor.authorSalminen, P-
dc.contributor.authorSong, HY-
dc.contributor.authorSøreide, JA-
dc.contributor.authorSpaander, MCW-
dc.contributor.authorTarascio, JN-
dc.contributor.authorTsai, JA-
dc.contributor.authorVanuytsel, T-
dc.contributor.authorRosman, C-
dc.contributor.authorSiersema, PD-
dc.date.accessioned2021-11-25T08:21:56Z-
dc.date.available2021-11-25T08:21:56Z-
dc.date.issued2021-
dc.identifier.citationSurgical Endoscopy, 2021, v. 35 n. 7, p. 3492-3505-
dc.identifier.issn0930-2794-
dc.identifier.urihttp://hdl.handle.net/10722/308337-
dc.description.abstractBackground: 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.-
dc.languageeng-
dc.publisherSpringer New York LLC. The Journal's web site is located at http://link.springer-ny.com/link/service/journals/00464/-
dc.relation.ispartofSurgical Endoscopy-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectEsophageal rupture-
dc.subjectIndividual patient data meta-analysis-
dc.subjectTime of diagnosis-
dc.titleEarly diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta-analysis-
dc.typeArticle-
dc.identifier.emailLaw, S: slaw@hku.hk-
dc.identifier.authorityLaw, S=rp00437-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1007/s00464-020-07806-y-
dc.identifier.pmid32681374-
dc.identifier.pmcidPMC8195755-
dc.identifier.scopuseid_2-s2.0-85087960628-
dc.identifier.hkuros327035-
dc.identifier.volume35-
dc.identifier.issue7-
dc.identifier.spage3492-
dc.identifier.epage3505-
dc.publisher.placeUnited States-

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