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dc.contributor.authorVermeulen, Bram D.
dc.contributor.authorvan der Leeden, Britt
dc.contributor.authorAli, Jawad T.
dc.contributor.authorGudbjartsson, Tomas
dc.contributor.authorHermansson, Michael
dc.contributor.authorLow, Donald E.
dc.contributor.authorAdler, Douglas G.
dc.contributor.authorBotha, Abraham J.
dc.contributor.authorD’Journo, Xavier B.
dc.contributor.authorEroglu, Atila
dc.contributor.authorFerri, Lorenzo E.
dc.contributor.authorGubler, Christoph
dc.contributor.authorHaveman, Jan Willem
dc.contributor.authorKaman, Lileswar
dc.contributor.authorKozarek, Richard A.
dc.contributor.authorLaw, Simon
dc.contributor.authorLoske, Gunnar
dc.contributor.authorLindenmann, Joerg
dc.contributor.authorPark, Jung-Hoon
dc.contributor.authorRichardson, J. David
dc.contributor.authorSalminen, Paulina
dc.contributor.authorSong, Ho-Yong
dc.contributor.authorSøreide, Jon Arne
dc.contributor.authorSpaander, Manon
dc.contributor.authorTarascio, Jeffrey N.
dc.contributor.authorTsai, Jon A.
dc.contributor.authorVanuytsel, Tim
dc.contributor.authorRosman, Camiel
dc.contributor.authorSiersema, Peter D.
dc.contributor.authorvan der Bogt, Ruben D.
dc.contributor.authorBirch, Madeleine
dc.contributor.authorDubose, Joseph J.
dc.contributor.authorFox, Sam
dc.contributor.authorJaklitsch, Michael T.
dc.contributor.authorKuppusamy, Madhan K.
dc.contributor.authorPersson, Saga
dc.contributor.authorRice, Robert D.
dc.contributor.authorSmolle, Josef
dc.contributor.authorSmolle-Juettner, Freyja M.
dc.contributor.authorSudarshan, Monisha
dc.contributor.authorSutcliffe, Robert P.
dc.contributor.authorVidarsdottir, Halla
dc.contributor.authorViste, Asgaut
dc.PublishedSurgical Endoscopy. 2020, 1-14.
dc.description.abstractBackground Time of diagnosis (TOD) of benign esophageal perforation is regarded as an important risk factor for clinical outcome, although convincing evidence is lacking. The aim of this study is to assess whether time between onset of perforation and diagnosis is associated with clinical outcome in patients with iatrogenic esophageal perforation (IEP) and Boerhaave’s syndrome (BS). Methods We searched MEDLINE, Embase and Cochrane library through June 2018 to identify studies. Authors were invited to share individual patient data and a meta-analysis was performed (PROSPERO: CRD42018093473). Patients were subdivided in early (≤ 24 h) and late (> 24 h) TOD and compared with mixed effects multivariable analysis while adjusting age, gender, location of perforation, initial treatment and center. Primary outcome was overall mortality. Secondary outcomes were length of hospital stay, re-interventions and ICU admission. Results Our meta-analysis included IPD of 25 studies including 576 patients with IEP and 384 with BS. In IEP, early TOD was not associated with overall mortality (8% vs. 13%, OR 2.1, 95% CI 0.8–5.1), but was associated with a 23% decrease in ICU admissions (46% vs. 69%, OR 3.0, 95% CI 1.2–7.2), a 22% decrease in re-interventions (23% vs. 45%, OR 2.8, 95% CI 1.2–6.7) and a 36% decrease in length of hospital stay (14 vs. 22 days, p < 0.001), compared with late TOD. In BS, no associations between TOD and outcomes were found. When combining IEP and BS, early TOD was associated with a 6% decrease in overall mortality (10% vs. 16%, OR 2.1, 95% CI 1.1–3.9), a 19% decrease in re-interventions (26% vs. 45%, OR 1.9, 95% CI 1.1–3.2) and a 35% decrease in mean length of hospital stay (16 vs. 22 days, p = 0.001), compared with late TOD. Conclusions This individual patient data meta-analysis confirms the general opinion that an early (≤ 24 h) compared to a late diagnosis (> 24 h) in benign esophageal perforations, particularly in IEP, is associated with improved clinical outcome.en_US
dc.rightsNavngivelse 4.0 Internasjonal*
dc.titleEarly diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta‑analysisen_US
dc.typeJournal articleen_US
dc.typePeer revieweden_US
dc.rights.holderCopyright The Author(s) 2020en_US
dc.source.journalSurgical Endoscopyen_US
dc.identifier.citationSurgical Endoscopy, 2020.en_US

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