Lucia Moletta
University of Padova, Italy
Title: Treatment of esophageal perforations: The role of the Pittsburgh Severity Score to guide the therapeutic approach
Biography
Biography: Lucia Moletta
Abstract
Esophageal perforation (EP) is characterized by high morbidity and mortality. The Pittsburgh Severity Score (PSS) is a scoring system based on clinical factors at the time of EP presentation, intended to guide treatment. The aim of the study is to verify PSS usefulness in stratifying EP severity and in guiding clinical decisions. All patients referred to our Unit for EP between January 2005 and January 2020 was enrolled. Patients were stratified according to their PSS into 3 groups (PSS 2; 3-5 and & gt; 5) the postoperative outcomes were compared. The predictive value of the PSS was evaluated by simple linear and logistic regression for the following outcomes: need for surgery, complications, in-hospital mortality, ICU and hospital stay, and time to refeeding and need for reintervention.
Seventy-three patients were referred for EP (M/F: 46/27). Perforations were more frequently iatrogenic (41.1%) or spontaneous (38.3 %). The median PSS was 4 (IQR 2-6). Surgery was required in 60.3% of cases. PSS was associated with ICU admission, hospital stay, need for surgery and reintervention, post- perforation complications and mortality. After regression analysis, PSS was significantly predictive of post perforation complications (p & lt; 0.01); in-hospital mortality (p=0.01); ICU admission (p & lt; 0.01); need for surgical treatment (p & lt; 0.01) and need for reintervention (p=0.02).
Conclusion: PSS is useful in stratifying patients in risk groups with different morbidity and mortality. It is also useful in guiding the therapeutic conduct, selecting patients for non-operative management. Prospective studies are needed to confirm the role of the PSS in the treatment of esophageal perforation.