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Early diagnosis is ...
Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation : an individual patient data meta-analysis
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- Vermeulen, Bram D. (författare)
- Radboud University Medical Center
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- van der Leeden, Britt (författare)
- Radboud University Medical Center
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- Ali, Jawad T. (författare)
- University of Texas at Austin
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- Gudbjartsson, Tomas (författare)
- National University Hospital of Iceland
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- Hermansson, Michael (författare)
- Lund University,Lunds universitet,Upper Gastrointestinal Surgery,Forskargrupper vid Lunds universitet,Lund University Research Groups,Skåne University Hospital
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- Low, Donald E. (författare)
- Virginia Mason Medical Center
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- Adler, Douglas G. (författare)
- University of Utah
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- Botha, Abraham J. (författare)
- Guy's and St Thomas' NHS Foundation Trust
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- D’Journo, Xavier B. (författare)
- Hopital Nord AP-HM,Aix-Marseille University
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- Eroglu, Atila (författare)
- Atatürk University
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- Ferri, Lorenzo E. (författare)
- McGill University,McGill University Health Centre, Montreal General Hospital
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- Gubler, Christoph (författare)
- University Hospital of Zurich
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- Haveman, Jan Willem (författare)
- University Medical Center Groningen
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- Kaman, Lileswar (författare)
- University Medical Center Groningen,University of Groningen
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- Kozarek, Richard A. (författare)
- Virginia Mason Medical Center
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- Law, Simon (författare)
- University of Hong Kong
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- Loske, Gunnar (författare)
- Marienkrankenhaus Hamburg
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- Lindenmann, Joerg (författare)
- Medical University of Graz
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- Park, Jung Hoon (författare)
- University of Ulsan
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- Richardson, J. David (författare)
- University of Louisville
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- Salminen, Paulina (författare)
- Turku University Hospital
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- Song, Ho Yong (författare)
- University of Ulsan
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- Søreide, Jon A. (författare)
- Stavanger University Hospital,University of Bergen
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- Spaander, Manon C.W. (författare)
- Erasmus University Medical Center
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- Tarascio, Jeffrey N. (författare)
- Brigham and Women's Hospital / Harvard Medical School
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- Tsai, Jon A. (författare)
- Karolinska Institute
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- Vanuytsel, Tim (författare)
- Catholic University of Leuven
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- Rosman, Camiel (författare)
- Radboud University Medical Center
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- Siersema, Peter D. (författare)
- Radboud University Medical Center
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(creator_code:org_t)
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- 2020-07-17
- 2021
- Engelska 14 s.
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Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 35:7, s. 3492-3505
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http://dx.doi.org/10... (free)
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https://link.springe...
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Abstract
Ämnesord
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- 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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Gastroenterologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
Nyckelord
- Esophageal rupture
- Individual patient data meta-analysis
- Time of diagnosis
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Vermeulen, Bram ...
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van der Leeden, ...
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Ali, Jawad T.
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Gudbjartsson, To ...
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Hermansson, Mich ...
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Low, Donald E.
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Adler, Douglas G ...
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Botha, Abraham J ...
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D’Journo, Xavier ...
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Eroglu, Atila
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Ferri, Lorenzo E ...
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Gubler, Christop ...
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Haveman, Jan Wil ...
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Kaman, Lileswar
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Kozarek, Richard ...
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Law, Simon
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Loske, Gunnar
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Lindenmann, Joer ...
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Park, Jung Hoon
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Richardson, J. D ...
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Salminen, Paulin ...
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Song, Ho Yong
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Søreide, Jon A.
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Spaander, Manon ...
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Tarascio, Jeffre ...
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Tsai, Jon A.
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Vanuytsel, Tim
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Rosman, Camiel
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Siersema, Peter ...
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- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Gastroenterologi
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Surgical Endosco ...
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Lunds universitet
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Karolinska Institutet