Outcomes after esophageal perforation: A tertiary referral center series

Esophageal perforation (EP) is a rare, life-threatening condition associated with high morbidity and mortality. This study aimed to evaluate the clinical factors associated with mortality and to assess the predictive performance of commonly used clinical severity scoring systems, including the Pittsburgh Severity Score (PSS), ASA physical status classification, and quick Sequential Organ Failure Assessment (qSOFA) score, in patients with EP.

A retrospective analysis of patients treated for EP at a tertiary referral center between 2023 and 2025 was performed. Survivors and non-survivors were compared using non-parametric tests. Effect sizes were calculated using Cliff's delta and Cramér's V. Receiver operating characteristic (ROC) analysis was used to evaluate the discriminatory performance of the PSS for mortality.

Eleven patients were included in the study. Thoracic imaging findings (pneumomediastinum and pleural effusion) and clinical indicators of systemic deterioration showed large effect sizes for mortality. PSS was the only variable significantly associated with mortality (p = 0.033) and demonstrated a large effect size (Cliff's δ = -0.80). An ROC analysis showed excellent discriminatory performance (AUC = 0.90), with a cutoff value of 6.5 predicting mortality with 100% sensitivity and 67% specificity. The overall mortality rate was 45.5%.

Early recognition and appropriate managementof esophageal perforation are crucial for improving clinical outcomes. Among the evaluated severity scoring systems, the Pittsburgh Severity Score demonstrated the strongest association with mortality and excellent discriminative performance. These findings suggest that the PSS is a practical tool for early risk stratification and management guidance in high-risk patients with esophageal perforation.