High mortality rate of oesophageal perforation is associated with delayed hospital admission : a prospective observational case series study

Background: To assess mortality rate of oesophageal perforation cases and study their etiology, diagnosis and management in a single specialized UK centre.

Patients and methods: A prospective observational study was performed between January 2012 and January 2015. All consecutive patients admitted with acute iatrogenic or spontaneous esophageal perforation were included. Anastomotic leak patients were excluded. Patients were managed conservatively, endoscopically, surgically or with a combination of the above. Primary outcome was mortality rate and its association with time to hospital admission. Secondary outcomes were nature of perforation, anatomic location, type of management as well as length of hospital stay and surgical complication rate.

Results: There were 13 cases included. Mean patients’ age was 58.3 years. Overall 90-day mortality rate was 38.4% (n=5), while 30-day mortality rate 30.8% (n=4). Admission within 24 hours of perforation was recorded in 69.2% of patients (n=9). The main anatomic location of perforation was the lower third of the esophagus in 53.8% (n=7). Operative management was adopted in 53.8% of cases (n=7). Mean hospital stay was 58.3 days. Mean follow-up was 3.1 years, while no patient developed any complication from the perforation or surgery.

Conclusions: Mortality following esophageal perforation is at approximately 40%, while there is a significant impact of time of presentation on prognosis.

Keywords: esophageal, esophageal perforation, Boerhaave’s syndrome, mortality.