Document Detail


How to treat esophageal perforations when determinants and predictors of mortality are considered.
MedLine Citation:
PMID:  19189177     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Published lethality rates of esophageal perforation (EP) vary depending on patient- and disease-related factors. This study was designed to evaluate how these factors impact death. Furthermore, we calculated the predictive accuracy of the Mortality Prediction Model (MPM II) and the Simplified Acute Physiology Score (SAPS II) for in-hospital death. Conclusions about treatment decisions were drawn based on our data and analysis of recent literature. METHODS: Every patient who was treated for EP at our department from December 2001 to July 2008 is included in this study. Logistic regression analyses of various risk factors, such as etiology, time interval, size, comorbidities, localization, type of treatment, and preexisting pathologies of the esophagus on death, were performed. RESULTS: Of the 41 patients diagnosed with EP, nine died (21%). The most important risk factor concerning death was cirrhosis of the liver (0 vs. 89% mortality; odds ratio, 208; P<0.001). Accuracy for lethality risk prediction was calculated with MPM II and SAPS II on admission, and afterward the characteristic increase that occurred was evaluated by using receiver operator characteristic curves. Optimal results were achieved by using a characteristic SAPS II increase (AUC 0.86; P: 0.009) after the patient was admitted to the intensive care unit. CONCLUSIONS: Our study was the first to demonstrate that a rapid or continuous increase more than 40 of the daily SAPS II clearly indicates that a high risk of death is imminent. This should be used as a reevaluation factor when choosing a treatment strategy.
Authors:
Andrej Udelnow; Markus Huber-Lang; Markus Juchems; Karl Träger; Doris Henne-Bruns; Peter Würl
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  World journal of surgery     Volume:  33     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-16     Completed Date:  2009-07-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  787-96     Citation Subset:  IM    
Affiliation:
Department of Surgery, St. Franziskus Hospital Flensburg, Waldstr. 17, 24939, Flensburg, Germany. andrej.udelnow@malteser.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Comorbidity
Decision Trees
Esophageal Perforation / etiology,  mortality*,  surgery*
Female
Health Status Indicators
Hospital Mortality
Humans
Liver Cirrhosis / epidemiology
Male
Middle Aged
Prognosis
Prospective Studies
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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