Eastern Cardiothoracic Surgical Society

Modern Outcomes in Surgical Repair of Esophageal Perforation
Chetan Pasrija, Brody Wehman, Zachary Kon, Diana Pratt, Isa Mohammed, Nimisha George, James Donahue, Whitney Burrows, University of Maryland, Baltimore, MD

OBJECTIVE: The aim of this study was to compare patient outcomes in modern versus conventional operative management for esophageal perforation.

METHODS: We performed a retrospective review of patients who underwent surgical repair for esophageal perforation from 2007-2013. Modern management techniques were defined as either a lack of surgical feeding tube placed at the time of esophageal repair or a surgery start time>24-hours from diagnosis. The primary outcome was one-year survival. Secondary outcomes included operative time, complication rate and esophageal leak rate. Severity of illness at admission was quantified by APACHE-II score.

RESULTS: The analysis included 32 consecutive patients (mean age=57.9 15.5, male=63%). Etiologies included Boorhaave s syndrome 72%(23) or iatrogenic 28%(9). Survival at one year was 84%(27) overall and 90%(27) in those who survived to discharge. Incidence of post-operative leak was 9.3%(mean POD14). 15(47%) patients suffered a post-operative complication. Patients who had a post-operative complication had a significantly higher admission APACHE-II score than those who did not (17.91 1.52vs.13.21 1.21,p= 0.026). There was no significant difference in adverse outcomes between those who underwent placement of a surgical feeding tube at the time of repair (n=13,40%) and those who did not. However intra-operative feeding tube placement significantly prolonged intra-operative time (380.9 19.9 vs. 302.3 19.2 mins,p=0.009). Patients with Boorhaave s syndrome who underwent repair>24-hours from diagnosis (n=12,52%) had equivalent outcomes to those repaired<24-hours.

CONCLUSIONS: Repair of esophageal perforation without intra-operative feeding tube placement has a shorter operative time and is not associated with adverse outcomes. Esophageal repair beyond 24-hours from diagnosis does not appear to adversely affect outcomes.