Abstract：
To evaluate outcomes associated with esophageal perforation (EP) management at a national level and determine predictive factors of 90-day mortality (90dM), failure-to-rescue (FTR), and major morbidity (MM, Clavien-Dindo 3-4).
EP remains a challenging clinical emergency. Previous population-based studies showed rates of 90dM up to 38.8% but were outdated or small-sized.
Data from patients admitted to hospitals with EP were extracted from the French medico-administrative database (2012-2021). Etiology, management strategies, and short and long-term outcomes were analyzed. A cutoff value of the annual EP management caseload affecting FTR was determined using the \"Chi-squared Automatic Interaction Detector\" method. Random effects logistic regression model was performed to assess independent predictors of 90dM, FTR, and MM.
Among 4765 patients with EP, 90dM and FTR rates were 28.0% and 19.4%, respectively. Both remained stable during the study period. EP was spontaneous in 68.2%, due to esophageal cancer in 19.7%, iatrogenic postendoscopy in 7.3%, and due to foreign body ingestion in 4.7%. Primary management consisted of surgery (n = 1447,30.4%), endoscopy (n = 590,12.4%), isolated drainage (n = 336,7.0%), and conservative management (n = 2392,50.2%). After multivariate analysis, besides age and comorbidity, esophageal cancer was predictive of both 90dM and FTR. An annual threshold of ≥8 EP managed annually was associated with a reduced 90dM and FTR rate. In France, only some university hospitals fulfilled this condition. Furthermore, primary surgery was associated with a lower 90dDM and FTR rate despite an increase in MM.
We provide evidence for the referral of EP to high-volume centers with multidisciplinary expertise. Surgery remains an effective treatment for EP.
EP remains a challenging clinical emergency. Previous population-based studies showed rates of 90dM up to 38.8% but were outdated or small-sized.
Data from patients admitted to hospitals with EP were extracted from the French medico-administrative database (2012-2021). Etiology, management strategies, and short and long-term outcomes were analyzed. A cutoff value of the annual EP management caseload affecting FTR was determined using the \"Chi-squared Automatic Interaction Detector\" method. Random effects logistic regression model was performed to assess independent predictors of 90dM, FTR, and MM.
Among 4765 patients with EP, 90dM and FTR rates were 28.0% and 19.4%, respectively. Both remained stable during the study period. EP was spontaneous in 68.2%, due to esophageal cancer in 19.7%, iatrogenic postendoscopy in 7.3%, and due to foreign body ingestion in 4.7%. Primary management consisted of surgery (n = 1447,30.4%), endoscopy (n = 590,12.4%), isolated drainage (n = 336,7.0%), and conservative management (n = 2392,50.2%). After multivariate analysis, besides age and comorbidity, esophageal cancer was predictive of both 90dM and FTR. An annual threshold of ≥8 EP managed annually was associated with a reduced 90dM and FTR rate. In France, only some university hospitals fulfilled this condition. Furthermore, primary surgery was associated with a lower 90dDM and FTR rate despite an increase in MM.
We provide evidence for the referral of EP to high-volume centers with multidisciplinary expertise. Surgery remains an effective treatment for EP.
摘要：
目的：在国家层面评估与食管穿孔（EP）治疗相关的结局，并确定90天死亡率（90dM）的预测因素，救援失败(FTR)，和主要发病率(MM，Clavien-Dindo3-4）。
背景：EP仍然是一种具有挑战性的临床急症。以前的基于人群的研究显示，发病率为90dM，高达38.8%，但已经过时或规模较小。
方法：从法国医学管理数据库（2012-2021年）中提取了入院的EP患者的数据。病因学,管理策略，并分析了短期和长期结果。使用“卡方自动交互检测器”方法确定影响FTR的年度EP管理案件量的截止值。采用随机效应logistic回归模型评估90dM的独立预测因子，FTR,嗯。
结果：在4765例EP患者中，90dM和FTR率分别为28.0%和19.4%，分别。两者在研究期间保持稳定。EP是自发的68.2％，因为19.7%的食管癌,医源性内镜检查后占7.3%，以及由于异物摄入占4.7%。主要管理包括手术（n=1447,30.4％），内窥镜检查（n=590,12.4%），隔离排水（n=336,7.0%），保守管理(n=2392,50.2%)。经过多变量分析，除了年龄和合并症，食管癌可预测90dM和FTR。每年管理≥8EP的年度阈值与90dM和FTR率降低有关。在法国,只有一些大学医院满足了这个条件。此外，尽管MMs增加,但初次手术与90dDM和FTR较低相关.
结论：我们为将EP转诊至具有多学科专业知识的高容量中心提供了证据。手术仍然是EP的有效治疗方法。
背景：EP仍然是一种具有挑战性的临床急症。以前的基于人群的研究显示，发病率为90dM，高达38.8%，但已经过时或规模较小。
方法：从法国医学管理数据库（2012-2021年）中提取了入院的EP患者的数据。病因学,管理策略，并分析了短期和长期结果。使用“卡方自动交互检测器”方法确定影响FTR的年度EP管理案件量的截止值。采用随机效应logistic回归模型评估90dM的独立预测因子，FTR,嗯。
结果：在4765例EP患者中，90dM和FTR率分别为28.0%和19.4%，分别。两者在研究期间保持稳定。EP是自发的68.2％，因为19.7%的食管癌,医源性内镜检查后占7.3%，以及由于异物摄入占4.7%。主要管理包括手术（n=1447,30.4％），内窥镜检查（n=590,12.4%），隔离排水（n=336,7.0%），保守管理(n=2392,50.2%)。经过多变量分析，除了年龄和合并症，食管癌可预测90dM和FTR。每年管理≥8EP的年度阈值与90dM和FTR率降低有关。在法国,只有一些大学医院满足了这个条件。此外，尽管MMs增加,但初次手术与90dDM和FTR较低相关.
结论：我们为将EP转诊至具有多学科专业知识的高容量中心提供了证据。手术仍然是EP的有效治疗方法。
