PENETRATING ESOPHAGEAL INJURIES - TIME-INTERVAL OF SAFETY FOR PREOPERATIVE EVALUATION - HOW LONG IS SAFE

Objectives: This study was performed to assess the experience with pen etrating esophageal injuries of an urban Level I trauma center and to attempt to correlate the time to establish a diagnosis with outcome in cluding death, surgical intensive care unit length of stay, and esopha geal-related complications, Methods: Retrospective study over a 72-mon th period at a single institution comparing age, admission blood press ure, Revised Trauma Score (RTS), Injury Severity Score (ISS), mechanis m and anatomic location of injury, and time interval from admission to the operating room (OR) between nonsurvivors and survivors, Patients who survived to reach the operating room were divided into two groups: those who went immediately to the operating room (no preoperative eva luation) and those who underwent diagnostic studies to identify their injuries (preoperative evaluation), Data analysis was done of the same parameters plus average number of associated injuries, complications, and intensive care unit length of stay. Statistical methods used univ ariate analysis (Fisher's exact test and Student's t test), Results: F orty-three patients were identified with penetrating esophageal injuri es and had the following characteristics: 36 males (84%) and 7 females (16%); mean RTS, 9.39; mean ISS, 28.1; mean time interval to OR, 9.8 hours, Associated injuries occurred with 42 patients (98%), The overal l complication rate was 14 of 32 (44%), and the overall mortality was 11 of 43 (26%), Corrected mortality was 22%, Differences were noted be tween nonsurvivors and survivors in the following parameters: admissio n blood pressure < 90, 11 of 11 versus 3 of 29 (p < 0.001); RTS, 2.364 versus 11.406 (p < 0.001); ISS, 45 versus 21 (p < 0.001); time interv al from admission to OR, 18.3 minutes versus 9.8 hours (p < 0.05), Thi rty-six patients survived to reach the operating room, 18 in the no pr eoperative evaluation group and 17 in the preoperative evaluation grou p, No statistically significant differences were noted between these t wo groups in the following parameters: age, RTS, ISS, admission blood pressure, anatomic location of injury, number of associated injuries, or intensive care unit length of stay, Average length of time to the o perating room was 16.7 hours in the preoperative evaluation group and 1.4 hours in the no preoperative evaluation group (p < 0.001), Twelve complications (all esophageal-related) occurred among seven patients i n the preoperative evaluation group, and seven complications (five eso phageal-related) occurred among seven patients in the no preoperative evaluation group, Because of the small sample size, this failed to rea ch a statistical difference (p < 0.05), Conclusions: Esophageal injuri es carry a high morbidity and mortality, Although no definite conclusi on can be drawn because of the small sample size, there does appear to be an increased morbidity associated with the diagnostic workup and i ts inherent delay in operative repair of these injuries, For centers p racticing selective management of penetrating neck injuries and transm ediastinal gunshot wounds, the rapid diagnosis and definitive repair o f esophageal injury should be made a high priority.