The incidence and long-term outcomes of esophageal perforations in Finland between 1996 and 2017 - a national registry-based analysis of 1106 esophageal perforations showing high early and late mortality rates and better outcomes in patients treated at high-volume centers.

Background: Esophageal perforations cause severe life-threatening diseases with significant mortality and morbidity. The national incidence and long-term prognosis of these patients is incompletely described in the current literature.Methods: Information regarding each treatment episode for esophageal perforations that had occurred in Finland between 1996 and 2017 and survival data of each patient was obtained from national registries. The occurrence of the disease, related interventions, the number and type of later treatment episodes, as well as the prognosis of these patients was analyzed.Results: The total number of patients with esophageal perforations was 1106 (median age 65, 38% female) and the median follow-up time was 113 months. The overall incidence of the disease was 0.95 (95% CI ± 0.12) per 100,000 person years with male predominance and a trend for slightly increasing occurrence. Esophageal cancer was present in 5.8% of cases. Altogether 41% of patients underwent invasive treatment (31% endoscopic stenting, 69% surgery). Particularly stenting was more frequent later in the series. The median number of disease-related hospitalizations was two and later out-patient clinic visits four. The overall 30-day, 90-day, 1-year and 5-year mortality rates were 14%, 22%, 31% and 46%, respectively, and significantly higher in malignancy-associated cases. There were no clear improvements in the mortality rates over the study period, but the prognosis was better in patients that were treated in higher volume hospitals.Conclusion: There is a slightly increasing trend in the occurrence of esophageal perforations. Contemporary treatment is less invasive with similar results. Patients treated in high-volume hospitals have better prognosis.