Prognostic evaluation of benign esophageal perforation with perforation severity score and Charlson comorbidity index score_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIN Weipeng , CUI Hongshang ,  SONG Yongbin

Department No.1 of Thoracic Surgery, Hebei General Hospital Affiliated to North China University of Science and Technology, Shijiazhuang, 050000, P.R.China;

Corresponding?author：

SONG Yongbin, Email: hebxwk@163.com

Keywords：

Pittsburgh scoring system; comorbidity index; benign perforation of esophagus

DOI：

10.7507/1007-4848.201810033

Video：

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Objective To evaluate the prognosis of benign esophageal perforation by Pittsburgh scoring system (perforation severity scores, PSS) combined with co-disease index (Charlson comorbidity index, CCI).Methods Thirty patients with benign esophageal perforation from August 2016 to August 2018 in our hospital diagnosed by imaging or endoscopy were selected, including 14 males and 16 females, aged 68.660±10.072 years. After treatment, we retrospectively analyzed whether there was any complication in the course of treatment, the healing of esophageal perforation at discharge and the follow-up after discharge. And the patients were divided into a stable group (20 patients with no complication, clear healing of esophageal perforation at discharge or death during follow-up) and an unstable condition group (10 patients with complications, esophageal perforation at discharge or death during follow-up). Complete clinical data of all the patients were obtained and were able to be calculated by the scores of PSS and CCI scoring system. The difference of PSS and CCI scores between the two groups was compared, and the clinical value of PSS combined with CCI score in the prognosis of benign esophageal perforation was analyzed.Results In the stable group, the PSS was 2.750±1.372 (95%CI 2.110 to 3.390), CCI score was 2.080±1.055 (95%CI 1.650 to 2.500) with a statistical difference between the two systems (P=0.000). In the unstable group, PSS was 7.300 ±1.829 (95%CI 7.300 to 8.120), CCI was 4.640±1.287 (95%CI 4.220 to 5.060) with a statistical difference between the two systems (P<0.05). The area under the receiver operating characteristic curve of PSS and CCI scores in the prognostic evaluation of benign esophageal perforation was 0.982 and 0.870 respectively, which was statistically significant (P<0.05).Conclusion Esophageal perforation is a dangerous condition. It is of great practical value to evaluate the condition of esophageal perforation by PSS and CCI scores.

Citation： LIN Weipeng, CUI Hongshang, SONG Yongbin. Prognostic evaluation of benign esophageal perforation with perforation severity score and Charlson comorbidity index score. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 648-652. doi: 10.7507/1007-4848.201810033 Copy

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2.	S?reide JA, Konradsson A, Sandvik OM, et al. Esophageal perforation: clinical patterns and outcomes from a patient cohort of Western Norway. Dig Surg, 2012, 29(6): 494-502.
3.	Spatola L, Finazzi S, Calvetta A, et al. Subjective global sssessment-dialysis malnutrition score and arteriovenous fistula outcome: A comparison with Charlson comorbidity index. J Vasc Access, 2019, 20(1):70-78.
4.	Kuppusamy MK, Hubka M, Felisky CD, et al. Evolving management strategies in esophageal perforation: surgeons using nonoperative techniques to improve outcomes. J Am Coll Surg, 2011, 213(1): 164-171.
5.	Garas G, Zarogoulidis P, Efthymiou A, et al. Spontaneous esophageal rupture as the underlying cause of pneumothorax: early recognition is crucial. J Thorac Dis, 2014, 6(12): 1655-1658.
6.	Griffiths EA, Yap N, Poulter J, et al. Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK. Dis Esophagus, 2009, 22(7): 616-625.
7.	張志偉, 原新會, 時加倫, 等. 自發性食管破裂 46 例治療體會. 長治醫學院學報, 2018, 32(2): 117-119.
8.	Arantes V, Campolina C, Valerio SH, et al. Flexible esophagoscopy as a diagnostic tool for traumatic esophageal injuries. J Trauma, 2009, 66(6): 1677-1682.
9.	S?reide JA, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med, 2011, 19: 66.
10.	Long CM, Ezenkwele UA. Esophageal perforation, rupture and tears. Google Scholar, 2009.
11.	羅慧良. 硫酸鋇對急性食管損傷癥狀的緩解作用. 四川醫學, 2000, 21(6): 548-549.
12.	Goldsmith P, Alkhaffaf B, Decadt B. Surgical management of esophageal perforation: a 10-year experience. Gastroenterology, 2013, 144(5): S-1077.
13.	Antonoff MB. Validation of the Pittsburgh esophageal perforation severity score: Further impetus for a prospective study. J Thorac Cardiovasc Surg, 2016, 151(4): 1012-1013.
14.	Schweigert M, Sousa HS, Solymosi N, et al. Spotlight on esophageal perforation: A multinational study using the Pittsburgh esophageal perforation severity scoring system. J Thorac Cardiovasc Surg, 2016, 151(4): 1002-1009.
15.	Feinstein AR. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis, 1970, 23(7): 455-468.

1. Abbas G, Schuchert MJ, Pettiford BL, et al. Contemporaneous management of esophageal perforation. Surg, 2009, 146(4): 749-755.
2. S?reide JA, Konradsson A, Sandvik OM, et al. Esophageal perforation: clinical patterns and outcomes from a patient cohort of Western Norway. Dig Surg, 2012, 29(6): 494-502.
3. Spatola L, Finazzi S, Calvetta A, et al. Subjective global sssessment-dialysis malnutrition score and arteriovenous fistula outcome: A comparison with Charlson comorbidity index. J Vasc Access, 2019, 20(1):70-78.
4. Kuppusamy MK, Hubka M, Felisky CD, et al. Evolving management strategies in esophageal perforation: surgeons using nonoperative techniques to improve outcomes. J Am Coll Surg, 2011, 213(1): 164-171.
5. Garas G, Zarogoulidis P, Efthymiou A, et al. Spontaneous esophageal rupture as the underlying cause of pneumothorax: early recognition is crucial. J Thorac Dis, 2014, 6(12): 1655-1658.
6. Griffiths EA, Yap N, Poulter J, et al. Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK. Dis Esophagus, 2009, 22(7): 616-625.
7. 張志偉, 原新會, 時加倫, 等. 自發性食管破裂 46 例治療體會. 長治醫學院學報, 2018, 32(2): 117-119.
8. Arantes V, Campolina C, Valerio SH, et al. Flexible esophagoscopy as a diagnostic tool for traumatic esophageal injuries. J Trauma, 2009, 66(6): 1677-1682.
9. S?reide JA, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med, 2011, 19: 66.
10. Long CM, Ezenkwele UA. Esophageal perforation, rupture and tears. Google Scholar, 2009.
11. 羅慧良. 硫酸鋇對急性食管損傷癥狀的緩解作用. 四川醫學, 2000, 21(6): 548-549.
12. Goldsmith P, Alkhaffaf B, Decadt B. Surgical management of esophageal perforation: a 10-year experience. Gastroenterology, 2013, 144(5): S-1077.
13. Antonoff MB. Validation of the Pittsburgh esophageal perforation severity score: Further impetus for a prospective study. J Thorac Cardiovasc Surg, 2016, 151(4): 1012-1013.
14. Schweigert M, Sousa HS, Solymosi N, et al. Spotlight on esophageal perforation: A multinational study using the Pittsburgh esophageal perforation severity scoring system. J Thorac Cardiovasc Surg, 2016, 151(4): 1002-1009.
15. Feinstein AR. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis, 1970, 23(7): 455-468.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognostic evaluation of benign esophageal perforation with perforation severity score and Charlson comorbidity index score

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