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

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dc.contributor.author the Benign Esophageal Perforation Collaborative Group
dc.date.accessioned 2022-04-14T01:01:45Z
dc.date.available 2022-04-14T01:01:45Z
dc.date.issued 2020-07-17
dc.identifier.citation the Benign Esophageal Perforation Collaborative Group 2020 , ' Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation : an individual patient data meta-analysis ' , Surgical Endoscopy , vol. 35 , no. 7 , pp. 3492-3505 . https://doi.org/10.1007/s00464-020-07806-y
dc.identifier.issn 0930-2794
dc.identifier.other PURE: 38373913
dc.identifier.other PURE UUID: 0658c7a4-2919-4ff0-88dc-b4f783470829
dc.identifier.other Scopus: 85087960628
dc.identifier.other unpaywall: 10.1007/s00464-020-07806-y
dc.identifier.uri https://hdl.handle.net/20.500.11815/3055
dc.description Publisher Copyright: © 2020, The Author(s). No funding was acquired for this study.
dc.description.abstract BACKGROUND: 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.format.extent 14
dc.format.extent 3492-3505
dc.language.iso en
dc.relation.ispartofseries Surgical Endoscopy; 35(7)
dc.rights info:eu-repo/semantics/openAccess
dc.subject Meltingarfærasjúkdómar
dc.subject Vélinda
dc.subject Esophageal rupture
dc.subject Individual patient data meta-analysis
dc.subject Time of diagnosis
dc.subject Length of Stay
dc.subject Mediastinal Diseases
dc.subject Humans
dc.subject Risk Factors
dc.subject Esophageal Perforation/diagnosis
dc.subject Early Diagnosis
dc.subject Surgery
dc.title Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation : an individual patient data meta-analysis
dc.type /dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article
dc.description.version Peer reviewed
dc.identifier.pmid 32681374
dc.identifier.doi https://doi.org/10.1007/s00464-020-07806-y
dc.relation.url http://www.scopus.com/inward/record.url?scp=85087960628&partnerID=8YFLogxK
dc.contributor.department Faculty of Medicine
dc.contributor.department Cardio-Vascular Center


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