M. Osama1, M. Hamidi1, A. Northcutt1, E. Zakaria1, N. Kulvatunyou1, T. O’Keeffe1, A. Tang1, L. Gries1, B. Joseph1 1University Of Arizona,Trauma And Acute Care Surgery,Tucson, AZ, USA
Introduction:
Blunt esophageal injuries are rare and their management is evolving. Diagnosis and management of these injuries remains a challenge. The aim of our study was to analyze the trends of operative intervention and mortality after blunt esophageal injuries.
Methods:
A 5-year (2010-2014) analysis of all trauma patients with esophageal injuries from the Trauma Quality Improvement Program (TQIP) was performed. All adult patients (>18 years) with blunt esophageal injuries were included. Patients were identified using ICD-9 codes and the following data points were obtained: demographics, admission vitals and procedures performed. Outcome measures were trends of operative intervention and mortality after esophageal injuries. Operative intervention was defined as any surgical procedure performed for the repair of esophagus (primary, secondary, diversion, and resection).
Results:
808,196 trauma patients were analyzed of which 153 patients had blunt esophageal injuries. Mean age was 43 ± 25 years, 75.2% (115) were male, and 79.7% (122) were white. Median [IQR] ISS was 21[9-34]. 75.2% (115) of the injuries were from motor vehicle collisions while 15.7% (24) were from falls. Overall, mortality rate was 17% (26) of which 50% were within the first 24 hours of injury and 19.1% in the following 7-days. 19.6% (30) patients underwent surgical intervention for repair of esophageal injuries. 14 patients had primary repair of laceration while 1 patient had resection of esophagus. The rate of operative intervention has increased while the mortality has decreased over the 5-years study period (Figure 1). On regression analysis, SBP (OR= 0.85; 95% CI, 0.61-091; p=0.01), pulse (OR= 1.31; 95% CI, 1.2-1.9; p<0.001), ISS (OR= 1.8; 95% CI, 1.3-2.5; p<0.001), and treatment at a non-teaching hospital (OR= 2.5; 95% CI, 1.5-6.6; p<0.001) were independently associated with mortality.
Conclusion:
The rate of operative intervention of esophageal injuries has increased while the mortality rate has decreased over the study period. Teaching status of hospital was associated with decrease in hospital mortality. Understanding why teaching hospitals have better outcomes may help improve survival from this rare injury.
