Factors affecting outcome in penetrating oesophageal trauma

BACKGROUND: Penetrating oesophageal trauma is rare and the risk factors affecting outcome have not been clearly identified. Delayed management has been cited as a factor contributing to the high rates of morbidity and mortality, but evidence for this is lacking. METHODS: A retrospective study was undertaken of patients with penetrating oesophageal trauma presenting to a level I trauma centre over 8 years. Outcome was assessed in terms of mortality, morbidity (oesophageal and non-oesophageal), and length of hospital and intensive care unit (ICU) stays. RESULTS: Fifty-two patients with oesophageal injury who reached the operating theatre were included. The overall mortality rate was 6 per cent. Fifteen patients (29 per cent) developed oesophageal injury-related complications. Time from injury to management was the only important risk factor for the development of oesophageal complications (P = 0.001), but did not affect the length of ICU (P = 0.560) or hospital (P = 0.329) stay, incidence of non-oesophageal injury-related complications (P = 0.963) or death (P = 0.937). Patients with gunshot injuries spent longer in the ICU (P = 0.007) and the duration of hospital stay was longer for those with higher-grade oesophageal injuries (P = 0.025). CONCLUSION: The risk of oesophageal injury-related complications was directly related to the interval between the trauma and definitive management of the oesophageal injury.