• Michael Schweigert, SousaHugo SantosHSHospital São João, Porto, Portugal., Norbert Solymosi, Aleksandar Yankulov, Marta Jiménez Fernández, Rory Beattie, Attila Dubecz, Charlotte Rabl, Simon Law, Daniel Tong, Danail Petrov, Annemaria Schäbitz, Rudolf J Stadlhuber, Julia Gumpp, Dietmar Ofner, Jim McGuigan, José Costa-Maia, Helmut Witzigmann, and Hubert J Stein.
• Department of General and Thoracic Surgery, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany. Electronic address: Schweigert-Mi@khdf.de.
• J. Thorac. Cardiovasc. Surg. 2016 Apr 1; 151 (4): 1002-9.

ObjectiveThe Pittsburgh group has suggested a perforation severity score (PSS) for better decision making in the management of esophageal perforation. Our study aim was to determine whether the PSS can be used to stratify patients with esophageal perforation into distinct subgroups with differential outcomes in an independent study population.MethodsIn a retrospective study cases of esophageal perforation were collected (study-period, 1990-2014). The PSS was analyzed using logistic regression as a continuous variable and stratified into low, intermediate, and high score groups.ResultsData for 288 patients (mean age, 59.9 years) presenting with esophageal perforation (during the period 1990-2014) were abstracted. Etiology was spontaneous (Boerhaave; n = 119), iatrogenic (instrumentation; n = 85), and traumatic perforation (n = 84). Forty-three patients had coexisting esophageal cancer. The mean PSS was 5.82, and was significantly higher in patients with fatal outcome (n = 57; 19.8%; mean PSS, 9.79 vs 4.84; P < .001). Mean PSS was also significantly higher in patients receiving operative management (n = 200; 69%; mean PSS, 6.44 vs 4.40; P < .001). Using the Pittsburgh strata, patients were assigned to low PSS (≤2; n = 63), intermediate PSS (3-5; n = 86), and high PSS (>5; n = 120) groups. Perforation-related morbidity, length of stay, frequency of operative treatment, and mortality increased with increasing PSS strata. Patients with high PSS were 3.37 times more likely to have operative management compared with low PSS.ConclusionsThe Pittsburgh PSS reliably reflects the seriousness of esophageal perforation and stratifies patients into low-, intermediate-, and high-risk groups with differential morbidity and mortality outcomes.Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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