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  • Vermeulen, Bram D.Radboud University Medical Center (författare)

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

  • Artikel/kapitelEngelska2021

Förlag, utgivningsår, omfång ...

  • 2020-07-17
  • Springer Science and Business Media LLC,2021
  • 14 s.

Nummerbeteckningar

  • LIBRIS-ID:oai:lup.lub.lu.se:eb97b745-1f0a-4e39-8b29-7e6fc57ae836
  • https://lup.lub.lu.se/record/eb97b745-1f0a-4e39-8b29-7e6fc57ae836URI
  • https://doi.org/10.1007/s00464-020-07806-yDOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:144189664URI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:art swepub-publicationtype
  • Ämneskategori:ref swepub-contenttype

Anmärkningar

  • 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 och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • van der Leeden, BrittRadboud University Medical Center (författare)
  • Ali, Jawad T.University of Texas at Austin (författare)
  • Gudbjartsson, TomasNational University Hospital of Iceland (författare)
  • Hermansson, MichaelLund University,Lunds universitet,Upper Gastrointestinal Surgery,Forskargrupper vid Lunds universitet,Lund University Research Groups,Skåne University Hospital(Swepub:lu)med-mho (författare)
  • Low, Donald E.Virginia Mason Medical Center (författare)
  • Adler, Douglas G.University of Utah (författare)
  • Botha, Abraham J.Guy's and St Thomas' NHS Foundation Trust (författare)
  • D’Journo, Xavier B.Aix-Marseille University,Hopital Nord AP-HM (författare)
  • Eroglu, AtilaAtatürk University (författare)
  • Ferri, Lorenzo E.McGill University,McGill University Health Centre, Montreal General Hospital (författare)
  • Gubler, ChristophUniversity Hospital of Zurich (författare)
  • Haveman, Jan WillemUniversity Medical Center Groningen (författare)
  • Kaman, LileswarUniversity of Groningen,University Medical Center Groningen (författare)
  • Kozarek, Richard A.Virginia Mason Medical Center (författare)
  • Law, SimonUniversity of Hong Kong (författare)
  • Loske, GunnarMarienkrankenhaus Hamburg (författare)
  • Lindenmann, JoergMedical University of Graz (författare)
  • Park, Jung HoonUniversity of Ulsan (författare)
  • Richardson, J. DavidUniversity of Louisville (författare)
  • Salminen, PaulinaTurku University Hospital (författare)
  • Song, Ho YongUniversity of Ulsan (författare)
  • Søreide, Jon A.University of Bergen,Stavanger University Hospital (författare)
  • Spaander, Manon C.W.Erasmus University Medical Center (författare)
  • Tarascio, Jeffrey N.Brigham and Women's Hospital / Harvard Medical School (författare)
  • Tsai, Jon A.Karolinska Institute (författare)
  • Vanuytsel, TimCatholic University of Leuven (författare)
  • Rosman, CamielRadboud University Medical Center (författare)
  • Siersema, Peter D.Radboud University Medical Center (författare)
  • Radboud University Medical CenterUniversity of Texas at Austin (creator_code:org_t)
  • the Benign Esophageal Perforation Collaborative Group

Sammanhörande titlar

  • Ingår i:Surgical Endoscopy: Springer Science and Business Media LLC35:7, s. 3492-35050930-27941432-2218

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