title: Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies.
abstract: BACKGROUND
  The mortality rate after oesophageal perforation is high despite advances in operative and non-operative techniques. In this study, we sought to identify risk factors for hospital mortality after oesophageal perforation treatment.
  
  
  METHODS
  We retrospectively examined patients treated for oesophageal perforation in a university teaching hospital in Hong Kong between January 1997 and December 2013. Their demographic and clinical characteristics, aetiology, management strategies, and outcomes were recorded and analysed.
  
  
  RESULTS
  We identified a cohort of 43 patients treated for perforation of the oesophagus (28 men; median age, 66 years; age range, 30-98 years). Perforation was spontaneous in 22 (51.2%) patients (15 with Boerhaave's syndrome and seven with malignant perforation), iatrogenic in 15 (34.9%), and provoked by foreign body ingestion in six (14.0%). Of the patients, 14 (32.6%) had pre-existing oesophageal disease. Perforation occurred in the intrathoracic oesophagus in 30 (69.8%) patients. Emergent surgery was undertaken in 23 patients: 16 underwent primary repair, six surgical drainage or exclusion, and one oesophagectomy. Twenty patients were managed non-operatively, 13 of whom underwent stenting. Two stented patients subsequently required oesophagectomy. Four patients had clinical signs of leak after primary repair: two were treated conservatively and two required oesophagectomy. Overall, six (14.0%) patients required oesophagectomy, one of whom died. Nine other patients also died in hospital; the hospital mortality rate was 23.3%. Pre-existing pulmonary and hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality (P=0.03, <0.01, and <0.01, respectively).
  
  
  CONCLUSIONS
  Most oesophageal perforations were spontaneous. Mortality was substantial despite modern therapies. Presence of pre-existing pulmonary disease, hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality. Salvage oesophagectomy was successful in selected patients.
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: T T
authors.initials: TT
authors.lastname: Law
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: J Yl
authors.initials: JY
authors.lastname: Chan
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: D Kk
authors.initials: DK
authors.lastname: Chan
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: D
authors.initials: D
authors.lastname: Tong
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: I Yh
authors.initials: IY
authors.lastname: Wong
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: F Sy
authors.initials: FS
authors.lastname: Chan
authors.affiliation: Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: S
authors.initials: S
authors.lastname: Law
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000150:complications; D004939:Esophageal Perforation / Q000150:complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005547:Foreign Bodies / Q000150:complications*; D006723:Hong Kong; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000150:complications; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation
keywords: Esophageal perforation; Esophagectomy; Mortality; Treatment outcome