| Introduction: Esophageal perforations caused by non-malignant diseases are still
associated with high morbidity and mortality rates. The purpose of this study was to
identify risk factors associated with survival.
Material and Methods: Eighty-two patients between 18 and 90 years of age treated
for non-malignant esophageal perforations between 1
st of January 2004 to 1
st of
January 2023 at the Division of Thoracic Surgery and Hyperbaric Surgery at the
Medical University of Graz were included in this study. The primary objective was
overall survival. Secondary objectives were biometric data (height, weight and BMI),
sex, risk factors (alcohol, nicotine), comorbidities, intra- and perioperative
complications as well as the duration of stay at intensive care units and general
wards. The data were analyzed with STAT-A.
Results: 29 (35,37%) women and 53 (64,63%) men were included. With a hazard
ratio (HR) for risk of death for men of 1,992708 when compared to women the risk
of the former was almost twice as high (p=0,039), though men were 10 years
younger than women (mean age: 59,3 ±14,7 years versus 69,9 ±14,9 years;
p=0,0057) at the time of perforation. Risk factors in the patients´ history, such as
smoking and high consumption of alcohol, were much more prevalent in men. In the
total collective mortality was significantly higher in smokers with a hazard ratio of
2.094124, indicating a risk twice as high than in non-smokers. In general, patients
with comorbidities had a three times higher mortality risk than patients who had been
healthy until perforation (HR: 3.62818; p=0.002). Especially nicotine-associated
diseases had a high impact on the long-term survival. Hazard ratio for COPD was
1.739515 (p=0.015) and the HR for heard diseases was as high as 2.854773
(p=0.002). The mean hospital stay (ICU and general ward combined) in the entire
study population was 29 days. On an average, the patients had to be treated for 13
days in an intensive care unit, and the risk of early death correlated with the duration
of the ICU stay (p=0.005). CRP and albumin, measured before the operation, on
the 1st and 3
rd day postoperative had no impact on long term-survival. However, the
rate of complications was statistically significant (p=0.0068) lower in patients who
had higher albumin values before the operation.
Conclusion: In this study it was possible to identify potential factors associated with
higher mortality in non-malignant esophageal perforation. The risk of men, who were
v
more frequently affected by this condition was twice as high than that of women,
even though men were significantly younger at the time of perforation. This could
be due to a comparatively higher consumption of nicotine and alcohol in men, habits
that have been known to trigger comorbidities such as COPD and heart disease
which had a significant, negative impact on the survival rate in the present study.
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