206: COULD THE PITTSBURGH SEVERITY SCORE GUIDE THE TREATMENT OF ESOPHAGEAL PERFORATION? EXPERIENCE OF A SINGLE REFERRAL CENTER

Abstract

Abstract Background and aim Esophageal perforation (EP) is characterized by high morbidity and mortality. In recent years, non-operative management has proved to be successful in selected patients. However, there is a lack of data supporting the superiority of one approach over the others and there is no consensus on the treatment algorithm. 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. Methods All patients referred to our Unit for EP between January 2005 and January 2020 were enrolled. Patients were stratified according to their PSS into 3 groups (PSS ≤ 2; 3–5 and > 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, time to refeeding and need for reintervention. Results Seventy-three patients were referred for EP (M/F: 46/27). Perforations were more frequently iatrogenic (41.1%) or spontaneous (37.0%). The median PSS was 4 (IQR 2–6). Surgery was required in 60.3% of cases. The median PSS was significantly lower in the conservative group (P < 0.01). PSS was significantly 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 < 0.01); in-hospital mortality (P = 0.01); ICU admission (P < 0.01); need for surgical treatment (P < 0.01) and need for reintervention (P = 0.02). The receiver-operator curve (ROC) analysis showed that a PSS ≥ 3 had good sensitivity and specificity for the main postoperative outcomes considered. 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 nonoperative management. Prospective studies are needed to confirm the role of the PSS in the treatment of esophageal perforation.