Non-iatrogenic esophageal injury: a retrospective analysis from the National Trauma Data Bank

• Type of Material: Article
• Authors: Alberto Aiolfi, University of Milan; Kenji Inaba, University of Southern California; Gustavo Recinos, University of Southern California; Desmond Khor, University of Southern California; Elizabeth Benjamin, Emory University; Lydia Lam, University of Southern California; Aaron Strumwasser, University of Southern California; Emanuele Asti, University of Milan; Luigi Bonavina, University of Milan; Demetrios Demetriades, University of Southern California
• Language: English
• Date: 2017-04-27
• Publisher: BIOMED CENTRAL LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2017 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13017-017-0131-8
• Title of Journal or Parent Work: WORLD JOURNAL OF EMERGENCY SURGERY
• Volume: 12
• Issue: 1
• Start Page: 19
• End Page: 19
• Grant/Funding Information: None
• Keywords: Esophageal trauma; Non-iatrogenic esophageal injury; Science & Technology; MULTICENTER; Life Sciences & Biomedicine; DIAGNOSIS; Primary suture; CHALLENGE; Surgery; MANAGEMENT; OUTCOMES; EXPERIENCE; Emergency Medicine; Outcomes; PERFORATION
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology; Health Sciences, Health Care Management

Abstract

Background: Traumatic, non-iatrogenic esophageal injuries, despite their rarity, are associated with significant morbidity and mortality. The optimal management of these esophageal perforations remains largely debated. To date, only a few small case series are available with contrasting results. The purpose of this study was to examine a large contemporary experience with traumatic esophageal injury management and to analyze risk factors associated with mortality. Methods: This National Trauma Data Bank (NTDB) database study included patients with non-iatrogenic esophageal injuries. Variables abstracted were demographics, comorbidities, mechanism of injury, Abbreviated Injury Scale (AIS), esophageal Organ Injury Scale (OIS), Injury Severity Score (ISS), level of injury, vital signs, and treatment. Multivariate analysis was used to identify independent predictors for mortality and overall complications. Results: A total of 944 patients with non-iatrogenic esophageal injury were included in the final analysis. The cervical segment of the esophagus was injured in 331 (35%) patients. The unadjusted 24-h mortality (8.2 vs. 14%, p = 0.008), 30-day mortality (4.2 vs. 9.3%, p = 0.005), and overall mortality (7.9 vs. 13.5%, p = 0.009) were significantly lower in the group of patients with a cervical injury. The overall complication rate was also lower in the cervical group (19.8 vs. 27.1%, p = 0.024). Multilogistic regression analysis identified age >50, thoracic injury, high-grade esophageal injury (OIS IV-V), hypotension on admission, and GCS <9 as independent risk factors associated with increased mortality. Treatment within the first 24h was found to be protective (OR 0.284; 95% CI, 0.148-0.546; p<0.001). Injury to the thoracic esophagus was also an independent risk factor for overall complications (OR 1.637; 95% CI, 1.06-2.53; p = 0.026). Conclusions: Despite improvements in surgical technique and critical care support, the overall mortality for traumatic esophageal injury remains high. The presence of a thoracic esophageal injury and extensive esophageal damage are the major independent risk factors for mortality. Early surgical treatment, within the first 24h of admission, is associated with improved survival. Trial registration: iStar, HS-16-00883