SP6.2.3 Boerhaave's Syndrome vs Iatrogenic Oesophageal Perforation - A Comparison Between Aetiology. (9th August 2022)

• Record Type: Journal Article
• Authors: Alasmar, Mohamed; Shehata, Zak; Altarawni, Mohammad; Casey, Patrick; Melhado, Rachel; Sultan, Javed
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 5
• Publication Date: 2022-08-09
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac247.073
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Aim: Oesophageal perforation is a rare surgical condition with high mortality. Boerhaave's syndrome (BS) may be associated with worse outcomes due to the degree of mediastinal contamination when compared to 'clean' iatrogenic perforations. This study aims to assess the differences in treatment and outcome between these two groups. Methods: Data was collected from a tertiary centre from 2009–2021 (n=73, 42 BS, 31 Iatrogenic). Data was collected retrospectively using the electronic patient record. Complications were quantified using the comprehensive complication index (CCI). Univariate analysis was used to determine statistical significance. Results: BS had a higher 30-day mortality compared to iatrogenic perforations (21.4% vs 3.2% p=0.025), however this was no longer significant at 90 days and 1 year (21.4% vs 16.1% p=0.57, 21.4% vs 19.4% p=0.83). Iatrogenic perforations were more likely to be managed non-operatively (73.8% vs 25.8% p<0.001). All of the iatrogenic deaths that occurred between 30 days-1 year had been managed non-operatively. Median length of intensive care stay was higher in BS (15 days vs 6 days p=0.047), with no significant difference in median overall length of stay (48 days BS vs 38 days iatrogenic p=0.88). Median CCI was greater in BS (53.9 vs 29.6 p=0.002). Conclusion: Whilst CCI and 30-day mortality was higher in Boerhaave's there was no difference in 90-day and 1 year mortality suggesting that long-term survival is not dictated by aetiology of the perforation. Most of the iatrogenic perforation were managed non-operatively which raises the question whether iatrogenic perforation should be managed more aggressively.