Penetrating esophageal injuries: Multicenter study of the American Association for the Surgery of Trauma

Juan A. Asensio, Santiago Chahwan, Walter Forno, Robert MacKersie, Matthew Wall, Jeffrey Lake, Gayle Minard, Orlando Kirton, Kimberly Nagy, Riyad Karmy-Jones, Susan Brundage, David Hoyt, Robert Winchell, Kurt Kralovich, Marc Shapiro, Robert Falcone, Emmett McGuire, Rao Ivatury, Michael Stoner, Jay YelonAnna Ledgerwood, Fred Luchette, C. William Schwab, Heidi Frankel, Bobby Chang, Robert Coscia, Kimball Maull, Dennis Wang, Erwin Hirsch, Jorge Cue, Dale Schmacht, Ernest Dunn, Frank Miller, Melissa Powell, John Sherck, Blaine Enderson, Loring Rue, Ralph Warren, Jorge Rodriquez, Michael West, Leonard Weireter, L. D. Britt, David Dries, C. Michael Dunham, Mark Malangoni, William Fallon, Ronald Simon, Richard Bell, David Hanpeter, Esteban Gambaro, Jose Ceballos, Javier Torcal, Kathy Alo, Emily Ramicone, Linda Chan

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

Objective: The purpose of this study was to define the period of time after which delays in management incurred by investigations cause increased morbidity and mortality. The outcome study is intended to correlate time with death from esophageal causes, overall complications, esophageal related complications, and surgical intensive care unit length of stay. Methods: This was a retrospective multicenter study involving 34 trauma centers in the United States, under the auspices of the American Association for the Surgery of Trauma Multi-institutional Trials Committee over a span of 10.5 years. Patients surviving to reach the operating room (OR) were divided into two groups: those that underwent diagnostic studies to identify their injuries (preoperative evaluation group) and those that went immediately to the OR (no preoperative evaluation group). Statistical methods included Fisher's exact test, Student's t test, and logistic regression analysis. Results: The study involved 405 patients: 355 male patients (86.5%) and 50 female patients (13.5%). The mean Revised Trauma Score was 6.3, the mean Injury Severity Score was 28, and the mean time interval to the OR was 6.5 hours. There were associated injuries in 356 patients (88%), and an overall complication rate of 53.5%. Overall mortality was 78 of 405 (19%). Three hundred forty-six patients survived to reach the OR: 171 in the preoperative evaluation group and 175 in the no preoperative evaluation group. No statistically significant differences were noted in the two groups in the following parameters: number of patients, age, Injury Severity Score, admission blood pressure, anatomic location of injury (cervical or thoracic), surgical management (primary repair, resection and anastomosis, resection and diversion, flaps), number of associated injuries, and mortality. Average length of time to the OR was 13 hours in the preoperative evaluation group versus 1 hour in the no preoperative evaluation group (p <0.001). Overall complications occurred in 134 in the preoperative evaluation group versus 87 in the no preoperative evaluation group (p <0.001), and 74 (41%) esophageal related complications occurred in the preoperative evaluation group versus 32 (19%) in the no preoperative evaluation group (p = 0.003). Mean surgical intensive care unit length of stay was 11 days in the preoperative evaluation group versus 7 days in the no preoperative evaluation group (p = 0.012). Logistic regression analysis identified as independent risk factors for the development of esophageal related complications included time delays in preoperative evaluation (odds ratio, 3.13), American Association for the Surgery of Trauma Organ Injury Scale grade >2 (odds ratio, 2.62), and resection and diversion (odds ratio, 4.47). Conclusion: Esophageal injuries carry a high morbidity and mortality. Increased esophageal related morbidity occurs with the diagnostic workup and its inherent delay in operative repair of these injuries. For centers practicing selective management of penetrating neck injuries and transmediastinal gunshot wounds, rapid diagnosis and definitive repair should be made a high priority.

Original languageEnglish
Pages (from-to)289-296
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume50
Issue number2
StatePublished - 2001
Externally publishedYes

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Multicenter Studies
Operating Rooms
Wounds and Injuries
Injury Severity Score
Mortality
Morbidity
Odds Ratio
Neck Injuries
Gunshot Wounds
Trauma Centers
Critical Care
Intensive Care Units
Cause of Death
Length of Stay
Thorax
Retrospective Studies
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Students

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Penetrating esophageal injuries : Multicenter study of the American Association for the Surgery of Trauma. / Asensio, Juan A.; Chahwan, Santiago; Forno, Walter; MacKersie, Robert; Wall, Matthew; Lake, Jeffrey; Minard, Gayle; Kirton, Orlando; Nagy, Kimberly; Karmy-Jones, Riyad; Brundage, Susan; Hoyt, David; Winchell, Robert; Kralovich, Kurt; Shapiro, Marc; Falcone, Robert; McGuire, Emmett; Ivatury, Rao; Stoner, Michael; Yelon, Jay; Ledgerwood, Anna; Luchette, Fred; Schwab, C. William; Frankel, Heidi; Chang, Bobby; Coscia, Robert; Maull, Kimball; Wang, Dennis; Hirsch, Erwin; Cue, Jorge; Schmacht, Dale; Dunn, Ernest; Miller, Frank; Powell, Melissa; Sherck, John; Enderson, Blaine; Rue, Loring; Warren, Ralph; Rodriquez, Jorge; West, Michael; Weireter, Leonard; Britt, L. D.; Dries, David; Dunham, C. Michael; Malangoni, Mark; Fallon, William; Simon, Ronald; Bell, Richard; Hanpeter, David; Gambaro, Esteban; Ceballos, Jose; Torcal, Javier; Alo, Kathy; Ramicone, Emily; Chan, Linda.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 50, No. 2, 2001, p. 289-296.

Research output: Contribution to journalArticle

Asensio, JA, Chahwan, S, Forno, W, MacKersie, R, Wall, M, Lake, J, Minard, G, Kirton, O, Nagy, K, Karmy-Jones, R, Brundage, S, Hoyt, D, Winchell, R, Kralovich, K, Shapiro, M, Falcone, R, McGuire, E, Ivatury, R, Stoner, M, Yelon, J, Ledgerwood, A, Luchette, F, Schwab, CW, Frankel, H, Chang, B, Coscia, R, Maull, K, Wang, D, Hirsch, E, Cue, J, Schmacht, D, Dunn, E, Miller, F, Powell, M, Sherck, J, Enderson, B, Rue, L, Warren, R, Rodriquez, J, West, M, Weireter, L, Britt, LD, Dries, D, Dunham, CM, Malangoni, M, Fallon, W, Simon, R, Bell, R, Hanpeter, D, Gambaro, E, Ceballos, J, Torcal, J, Alo, K, Ramicone, E & Chan, L 2001, 'Penetrating esophageal injuries: Multicenter study of the American Association for the Surgery of Trauma', Journal of Trauma - Injury, Infection and Critical Care, vol. 50, no. 2, pp. 289-296.
Asensio, Juan A. ; Chahwan, Santiago ; Forno, Walter ; MacKersie, Robert ; Wall, Matthew ; Lake, Jeffrey ; Minard, Gayle ; Kirton, Orlando ; Nagy, Kimberly ; Karmy-Jones, Riyad ; Brundage, Susan ; Hoyt, David ; Winchell, Robert ; Kralovich, Kurt ; Shapiro, Marc ; Falcone, Robert ; McGuire, Emmett ; Ivatury, Rao ; Stoner, Michael ; Yelon, Jay ; Ledgerwood, Anna ; Luchette, Fred ; Schwab, C. William ; Frankel, Heidi ; Chang, Bobby ; Coscia, Robert ; Maull, Kimball ; Wang, Dennis ; Hirsch, Erwin ; Cue, Jorge ; Schmacht, Dale ; Dunn, Ernest ; Miller, Frank ; Powell, Melissa ; Sherck, John ; Enderson, Blaine ; Rue, Loring ; Warren, Ralph ; Rodriquez, Jorge ; West, Michael ; Weireter, Leonard ; Britt, L. D. ; Dries, David ; Dunham, C. Michael ; Malangoni, Mark ; Fallon, William ; Simon, Ronald ; Bell, Richard ; Hanpeter, David ; Gambaro, Esteban ; Ceballos, Jose ; Torcal, Javier ; Alo, Kathy ; Ramicone, Emily ; Chan, Linda. / Penetrating esophageal injuries : Multicenter study of the American Association for the Surgery of Trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 2001 ; Vol. 50, No. 2. pp. 289-296.
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title = "Penetrating esophageal injuries: Multicenter study of the American Association for the Surgery of Trauma",
abstract = "Objective: The purpose of this study was to define the period of time after which delays in management incurred by investigations cause increased morbidity and mortality. The outcome study is intended to correlate time with death from esophageal causes, overall complications, esophageal related complications, and surgical intensive care unit length of stay. Methods: This was a retrospective multicenter study involving 34 trauma centers in the United States, under the auspices of the American Association for the Surgery of Trauma Multi-institutional Trials Committee over a span of 10.5 years. Patients surviving to reach the operating room (OR) were divided into two groups: those that underwent diagnostic studies to identify their injuries (preoperative evaluation group) and those that went immediately to the OR (no preoperative evaluation group). Statistical methods included Fisher's exact test, Student's t test, and logistic regression analysis. Results: The study involved 405 patients: 355 male patients (86.5{\%}) and 50 female patients (13.5{\%}). The mean Revised Trauma Score was 6.3, the mean Injury Severity Score was 28, and the mean time interval to the OR was 6.5 hours. There were associated injuries in 356 patients (88{\%}), and an overall complication rate of 53.5{\%}. Overall mortality was 78 of 405 (19{\%}). Three hundred forty-six patients survived to reach the OR: 171 in the preoperative evaluation group and 175 in the no preoperative evaluation group. No statistically significant differences were noted in the two groups in the following parameters: number of patients, age, Injury Severity Score, admission blood pressure, anatomic location of injury (cervical or thoracic), surgical management (primary repair, resection and anastomosis, resection and diversion, flaps), number of associated injuries, and mortality. Average length of time to the OR was 13 hours in the preoperative evaluation group versus 1 hour in the no preoperative evaluation group (p <0.001). Overall complications occurred in 134 in the preoperative evaluation group versus 87 in the no preoperative evaluation group (p <0.001), and 74 (41{\%}) esophageal related complications occurred in the preoperative evaluation group versus 32 (19{\%}) in the no preoperative evaluation group (p = 0.003). Mean surgical intensive care unit length of stay was 11 days in the preoperative evaluation group versus 7 days in the no preoperative evaluation group (p = 0.012). Logistic regression analysis identified as independent risk factors for the development of esophageal related complications included time delays in preoperative evaluation (odds ratio, 3.13), American Association for the Surgery of Trauma Organ Injury Scale grade >2 (odds ratio, 2.62), and resection and diversion (odds ratio, 4.47). Conclusion: Esophageal injuries carry a high morbidity and mortality. Increased esophageal related morbidity occurs with the diagnostic workup and its inherent delay in operative repair of these injuries. For centers practicing selective management of penetrating neck injuries and transmediastinal gunshot wounds, rapid diagnosis and definitive repair should be made a high priority.",
author = "Asensio, {Juan A.} and Santiago Chahwan and Walter Forno and Robert MacKersie and Matthew Wall and Jeffrey Lake and Gayle Minard and Orlando Kirton and Kimberly Nagy and Riyad Karmy-Jones and Susan Brundage and David Hoyt and Robert Winchell and Kurt Kralovich and Marc Shapiro and Robert Falcone and Emmett McGuire and Rao Ivatury and Michael Stoner and Jay Yelon and Anna Ledgerwood and Fred Luchette and Schwab, {C. William} and Heidi Frankel and Bobby Chang and Robert Coscia and Kimball Maull and Dennis Wang and Erwin Hirsch and Jorge Cue and Dale Schmacht and Ernest Dunn and Frank Miller and Melissa Powell and John Sherck and Blaine Enderson and Loring Rue and Ralph Warren and Jorge Rodriquez and Michael West and Leonard Weireter and Britt, {L. D.} and David Dries and Dunham, {C. Michael} and Mark Malangoni and William Fallon and Ronald Simon and Richard Bell and David Hanpeter and Esteban Gambaro and Jose Ceballos and Javier Torcal and Kathy Alo and Emily Ramicone and Linda Chan",
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TY - JOUR

T1 - Penetrating esophageal injuries

T2 - Multicenter study of the American Association for the Surgery of Trauma

AU - Asensio, Juan A.

AU - Chahwan, Santiago

AU - Forno, Walter

AU - MacKersie, Robert

AU - Wall, Matthew

AU - Lake, Jeffrey

AU - Minard, Gayle

AU - Kirton, Orlando

AU - Nagy, Kimberly

AU - Karmy-Jones, Riyad

AU - Brundage, Susan

AU - Hoyt, David

AU - Winchell, Robert

AU - Kralovich, Kurt

AU - Shapiro, Marc

AU - Falcone, Robert

AU - McGuire, Emmett

AU - Ivatury, Rao

AU - Stoner, Michael

AU - Yelon, Jay

AU - Ledgerwood, Anna

AU - Luchette, Fred

AU - Schwab, C. William

AU - Frankel, Heidi

AU - Chang, Bobby

AU - Coscia, Robert

AU - Maull, Kimball

AU - Wang, Dennis

AU - Hirsch, Erwin

AU - Cue, Jorge

AU - Schmacht, Dale

AU - Dunn, Ernest

AU - Miller, Frank

AU - Powell, Melissa

AU - Sherck, John

AU - Enderson, Blaine

AU - Rue, Loring

AU - Warren, Ralph

AU - Rodriquez, Jorge

AU - West, Michael

AU - Weireter, Leonard

AU - Britt, L. D.

AU - Dries, David

AU - Dunham, C. Michael

AU - Malangoni, Mark

AU - Fallon, William

AU - Simon, Ronald

AU - Bell, Richard

AU - Hanpeter, David

AU - Gambaro, Esteban

AU - Ceballos, Jose

AU - Torcal, Javier

AU - Alo, Kathy

AU - Ramicone, Emily

AU - Chan, Linda

PY - 2001

Y1 - 2001

N2 - Objective: The purpose of this study was to define the period of time after which delays in management incurred by investigations cause increased morbidity and mortality. The outcome study is intended to correlate time with death from esophageal causes, overall complications, esophageal related complications, and surgical intensive care unit length of stay. Methods: This was a retrospective multicenter study involving 34 trauma centers in the United States, under the auspices of the American Association for the Surgery of Trauma Multi-institutional Trials Committee over a span of 10.5 years. Patients surviving to reach the operating room (OR) were divided into two groups: those that underwent diagnostic studies to identify their injuries (preoperative evaluation group) and those that went immediately to the OR (no preoperative evaluation group). Statistical methods included Fisher's exact test, Student's t test, and logistic regression analysis. Results: The study involved 405 patients: 355 male patients (86.5%) and 50 female patients (13.5%). The mean Revised Trauma Score was 6.3, the mean Injury Severity Score was 28, and the mean time interval to the OR was 6.5 hours. There were associated injuries in 356 patients (88%), and an overall complication rate of 53.5%. Overall mortality was 78 of 405 (19%). Three hundred forty-six patients survived to reach the OR: 171 in the preoperative evaluation group and 175 in the no preoperative evaluation group. No statistically significant differences were noted in the two groups in the following parameters: number of patients, age, Injury Severity Score, admission blood pressure, anatomic location of injury (cervical or thoracic), surgical management (primary repair, resection and anastomosis, resection and diversion, flaps), number of associated injuries, and mortality. Average length of time to the OR was 13 hours in the preoperative evaluation group versus 1 hour in the no preoperative evaluation group (p <0.001). Overall complications occurred in 134 in the preoperative evaluation group versus 87 in the no preoperative evaluation group (p <0.001), and 74 (41%) esophageal related complications occurred in the preoperative evaluation group versus 32 (19%) in the no preoperative evaluation group (p = 0.003). Mean surgical intensive care unit length of stay was 11 days in the preoperative evaluation group versus 7 days in the no preoperative evaluation group (p = 0.012). Logistic regression analysis identified as independent risk factors for the development of esophageal related complications included time delays in preoperative evaluation (odds ratio, 3.13), American Association for the Surgery of Trauma Organ Injury Scale grade >2 (odds ratio, 2.62), and resection and diversion (odds ratio, 4.47). Conclusion: Esophageal injuries carry a high morbidity and mortality. Increased esophageal related morbidity occurs with the diagnostic workup and its inherent delay in operative repair of these injuries. For centers practicing selective management of penetrating neck injuries and transmediastinal gunshot wounds, rapid diagnosis and definitive repair should be made a high priority.

AB - Objective: The purpose of this study was to define the period of time after which delays in management incurred by investigations cause increased morbidity and mortality. The outcome study is intended to correlate time with death from esophageal causes, overall complications, esophageal related complications, and surgical intensive care unit length of stay. Methods: This was a retrospective multicenter study involving 34 trauma centers in the United States, under the auspices of the American Association for the Surgery of Trauma Multi-institutional Trials Committee over a span of 10.5 years. Patients surviving to reach the operating room (OR) were divided into two groups: those that underwent diagnostic studies to identify their injuries (preoperative evaluation group) and those that went immediately to the OR (no preoperative evaluation group). Statistical methods included Fisher's exact test, Student's t test, and logistic regression analysis. Results: The study involved 405 patients: 355 male patients (86.5%) and 50 female patients (13.5%). The mean Revised Trauma Score was 6.3, the mean Injury Severity Score was 28, and the mean time interval to the OR was 6.5 hours. There were associated injuries in 356 patients (88%), and an overall complication rate of 53.5%. Overall mortality was 78 of 405 (19%). Three hundred forty-six patients survived to reach the OR: 171 in the preoperative evaluation group and 175 in the no preoperative evaluation group. No statistically significant differences were noted in the two groups in the following parameters: number of patients, age, Injury Severity Score, admission blood pressure, anatomic location of injury (cervical or thoracic), surgical management (primary repair, resection and anastomosis, resection and diversion, flaps), number of associated injuries, and mortality. Average length of time to the OR was 13 hours in the preoperative evaluation group versus 1 hour in the no preoperative evaluation group (p <0.001). Overall complications occurred in 134 in the preoperative evaluation group versus 87 in the no preoperative evaluation group (p <0.001), and 74 (41%) esophageal related complications occurred in the preoperative evaluation group versus 32 (19%) in the no preoperative evaluation group (p = 0.003). Mean surgical intensive care unit length of stay was 11 days in the preoperative evaluation group versus 7 days in the no preoperative evaluation group (p = 0.012). Logistic regression analysis identified as independent risk factors for the development of esophageal related complications included time delays in preoperative evaluation (odds ratio, 3.13), American Association for the Surgery of Trauma Organ Injury Scale grade >2 (odds ratio, 2.62), and resection and diversion (odds ratio, 4.47). Conclusion: Esophageal injuries carry a high morbidity and mortality. Increased esophageal related morbidity occurs with the diagnostic workup and its inherent delay in operative repair of these injuries. For centers practicing selective management of penetrating neck injuries and transmediastinal gunshot wounds, rapid diagnosis and definitive repair should be made a high priority.

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