The following is a summary of “Multicenter, Prospective Cohort Study of Oesophageal Injuries and Related Clinical Outcomes (MUSOIC study),” published in the December 2023 issue of Surgery by Owen, et al.
For a study, researchers sought to find out what factors affect a patient’s prognosis for death within 90 days after they have an esophageal perforation and to describe the exact time it takes from appearance to action and how it relates to death. Esophageal perforation is a rare emergency surgery in the GI tract that has a high death rate. However, there needed to be more information on how well it works with centralized esophagogastric services, updated agreement standards, or new ways to treat the condition without surgery. The study used prospective cohorts at eight high-volume esophagogastric centers from January 2016 to December 2020.
The primary outcome measure was death within 90 days. Longer hospital and ICU stays, and problems that needed re-intervention or re-admission were used as secondary measures. Random forest, support vector machines, and logistic regression with and without elastic net regularization were used to train the mortality model. Chronological research was done by looking at the time points in each patient’s trip based on when their symptoms started. 18.9% of the 369 patients who were included died. The death rates for patients treated carefully, endoscopically, surgically, or with a combination of these methods were 24.1%, 23.7%, 8.7%, and 18.2%, respectively.
The Charlson comorbidity index, the number of red blood cells, white blood cells, creatinine levels, the reason for the hole, the presence of cancer, the move to a hospital, the results of the CT scan, the type of intervention, whether a contrast swallow was made were all factors that could predict death. The stepwise interval model showed that the longest time between diagnosis and death was the main cause of death. Perforation management methods that don’t involve surgery have better results and may be chosen in some groups. Better risk classification based on the above-mentioned changeable risk factors can improve outcomes.
