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.