Multicenter, prospective cohort study of oesophageal injuries and related clinical outcomes (MUSOIC study)
<p><strong>Objective:</strong> To identify prognostic factors associated with 90-day mortality in patients with oesophageal perforation (OP), and characterize the specific timeline from presentation to intervention, and its relation to mortality.</p> <p><strong>B...
| Main Authors: | , , , , , , , , , , , |
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| Other Authors: | |
| Format: | Journal article |
| Language: | English |
| Published: |
Lippincott, Williams & Wilkins
2023
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| _version_ | 1811139174716145664 |
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| author | Owen, RP Chidambaram, S Griffiths, EA Sultan, J Phillips, AW Vohra, R Preston, S Gossage, J Hanna, GB Underwood, TJ Maynard, N Markar, SR |
| author2 | MUSOIC Study Group |
| author_facet | MUSOIC Study Group Owen, RP Chidambaram, S Griffiths, EA Sultan, J Phillips, AW Vohra, R Preston, S Gossage, J Hanna, GB Underwood, TJ Maynard, N Markar, SR |
| author_sort | Owen, RP |
| collection | OXFORD |
| description | <p><strong>Objective:</strong> To identify prognostic factors associated with 90-day mortality in patients with oesophageal perforation (OP), and characterize the specific timeline from presentation to intervention, and its relation to mortality.</p>
<p><strong>Background:</strong> OP is a rare gastro-intestinal surgical emergency with a high mortality rate. However, there is no updated evidence on its outcomes in the context of centralized esophago-gastric services; updated consensus guidelines; and novel non-surgical treatment strategies.</p>
<p><strong>Methods:</strong> A multi-center, prospective cohort study involving eight high-volume esophago-gastric centers (January 2016 to December 2020) was undertaken. The primary outcome measure was 90-day mortality. Secondary measures included length of hospital and ICU stay, and complications requiring re-intervention or re-admission. Mortality model training was performed using random forest, support-vector machines, and logistic regression with and without elastic net regularisation. Chronological analysis was performed by examining each patient’s journey timepoint with reference to symptom onset.</p>
<p><strong>Results:</strong> The mortality rate for 369 patients included was 18.9%. Patients treated conservatively, endoscopically, surgically, or combined approaches had mortality rates of 24.1%, 23.7%, 8.7%, and 18.2%, respectively. The predictive variables for mortality were Charlson comorbidity index, haemoglobin count, leucocyte count, creatinine levels, cause of perforation, presence of cancer, hospital transfer, CT findings, whether a contrast swallow was performed, and intervention type. Stepwise interval model showed that time to diagnosis was the most significant contributor to mortality.</p>
<p><strong>Conclusion:</strong> Non-surgical strategies have better outcomes and may be preferred in selected cohorts to manage perforations. Outcomes can be significantly improved through better risk-stratification based on afore-mentioned modifiable risk factors.</p> |
| first_indexed | 2024-03-07T07:47:03Z |
| format | Journal article |
| id | oxford-uuid:7f4a991b-4ce2-46a4-a760-a2d2e746ea8e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:01:54Z |
| publishDate | 2023 |
| publisher | Lippincott, Williams & Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:7f4a991b-4ce2-46a4-a760-a2d2e746ea8e2024-04-29T08:57:22ZMulticenter, prospective cohort study of oesophageal injuries and related clinical outcomes (MUSOIC study)Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:7f4a991b-4ce2-46a4-a760-a2d2e746ea8eEnglishSymplectic ElementsLippincott, Williams & Wilkins2023Owen, RPChidambaram, SGriffiths, EASultan, JPhillips, AWVohra, RPreston, SGossage, JHanna, GBUnderwood, TJMaynard, NMarkar, SRMUSOIC Study Group<p><strong>Objective:</strong> To identify prognostic factors associated with 90-day mortality in patients with oesophageal perforation (OP), and characterize the specific timeline from presentation to intervention, and its relation to mortality.</p> <p><strong>Background:</strong> OP is a rare gastro-intestinal surgical emergency with a high mortality rate. However, there is no updated evidence on its outcomes in the context of centralized esophago-gastric services; updated consensus guidelines; and novel non-surgical treatment strategies.</p> <p><strong>Methods:</strong> A multi-center, prospective cohort study involving eight high-volume esophago-gastric centers (January 2016 to December 2020) was undertaken. The primary outcome measure was 90-day mortality. Secondary measures included length of hospital and ICU stay, and complications requiring re-intervention or re-admission. Mortality model training was performed using random forest, support-vector machines, and logistic regression with and without elastic net regularisation. Chronological analysis was performed by examining each patient’s journey timepoint with reference to symptom onset.</p> <p><strong>Results:</strong> The mortality rate for 369 patients included was 18.9%. Patients treated conservatively, endoscopically, surgically, or combined approaches had mortality rates of 24.1%, 23.7%, 8.7%, and 18.2%, respectively. The predictive variables for mortality were Charlson comorbidity index, haemoglobin count, leucocyte count, creatinine levels, cause of perforation, presence of cancer, hospital transfer, CT findings, whether a contrast swallow was performed, and intervention type. Stepwise interval model showed that time to diagnosis was the most significant contributor to mortality.</p> <p><strong>Conclusion:</strong> Non-surgical strategies have better outcomes and may be preferred in selected cohorts to manage perforations. Outcomes can be significantly improved through better risk-stratification based on afore-mentioned modifiable risk factors.</p> |
| spellingShingle | Owen, RP Chidambaram, S Griffiths, EA Sultan, J Phillips, AW Vohra, R Preston, S Gossage, J Hanna, GB Underwood, TJ Maynard, N Markar, SR Multicenter, prospective cohort study of oesophageal injuries and related clinical outcomes (MUSOIC study) |
| title | Multicenter, prospective cohort study of oesophageal injuries and related clinical outcomes (MUSOIC study) |
| title_full | Multicenter, prospective cohort study of oesophageal injuries and related clinical outcomes (MUSOIC study) |
| title_fullStr | Multicenter, prospective cohort study of oesophageal injuries and related clinical outcomes (MUSOIC study) |
| title_full_unstemmed | Multicenter, prospective cohort study of oesophageal injuries and related clinical outcomes (MUSOIC study) |
| title_short | Multicenter, prospective cohort study of oesophageal injuries and related clinical outcomes (MUSOIC study) |
| title_sort | multicenter prospective cohort study of oesophageal injuries and related clinical outcomes musoic study |
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