Spotlight on esophageal perforation: A multinational study using the Pittsburgh esophageal perforation severity scoring system

Michael Schweigert, Hugo Santos Sousa, N. Solymosi, Aleksandar Yankulov, Marta Jiménez Fernández, Rory Beattie, Attila Dubecz, Charlotte Rabl, Simon Law, Daniel Tong, Danail Petrov, Annemaria Schäbitz, Rudolf J. Stadlhuber, Julia Gumpp, Dietmar Ofner, Jim McGuigan, José Costa-Maia, Helmut Witzigmann, Hubert J. Stein

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28 Citations (Scopus)

Abstract

Objective The Pittsburgh group has suggested a perforation severity score (PSS) for better decision making in the management of esophageal perforation. Our study aim was to determine whether the PSS can be used to stratify patients with esophageal perforation into distinct subgroups with differential outcomes in an independent study population. Methods In a retrospective study cases of esophageal perforation were collected (study-period, 1990-2014). The PSS was analyzed using logistic regression as a continuous variable and stratified into low, intermediate, and high score groups. Results Data for 288 patients (mean age, 59.9 years) presenting with esophageal perforation (during the period 1990-2014) were abstracted. Etiology was spontaneous (Boerhaave; n = 119), iatrogenic (instrumentation; n = 85), and traumatic perforation (n = 84). Forty-three patients had coexisting esophageal cancer. The mean PSS was 5.82, and was significantly higher in patients with fatal outcome (n = 57; 19.8%; mean PSS, 9.79 vs 4.84; P 5; n = 120) groups. Perforation-related morbidity, length of stay, frequency of operative treatment, and mortality increased with increasing PSS strata. Patients with high PSS were 3.37 times more likely to have operative management compared with low PSS. Conclusions The Pittsburgh PSS reliably reflects the seriousness of esophageal perforation and stratifies patients into low-, intermediate-, and high-risk groups with differential morbidity and mortality outcomes.

Original languageEnglish
Pages (from-to)1002-1011
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number4
DOIs
Publication statusPublished - Apr 1 2016

Keywords

  • esophageal perforation
  • esophagus
  • foregut surgery
  • sepsis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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    Schweigert, M., Santos Sousa, H., Solymosi, N., Yankulov, A., Fernández, M. J., Beattie, R., Dubecz, A., Rabl, C., Law, S., Tong, D., Petrov, D., Schäbitz, A., Stadlhuber, R. J., Gumpp, J., Ofner, D., McGuigan, J., Costa-Maia, J., Witzigmann, H., & Stein, H. J. (2016). Spotlight on esophageal perforation: A multinational study using the Pittsburgh esophageal perforation severity scoring system. Journal of Thoracic and Cardiovascular Surgery, 151(4), 1002-1011. https://doi.org/10.1016/j.jtcvs.2015.11.055