172 The Incidence, Management and Outcomes for Patients with Boerhaave’s Syndrome Treated in a Tertiary Surgical Unit

Abstract Aim This study aimed to report the incidence, management and outcomes for patients developing Boerhaave’s syndrome in an NHS Scotland health board managed in a tertiary surgical unit over a 16-year period. Method A retrospective cohort study was conducted involving patients discharged from Aberdeen Royal Infirmary, NHS Grampian, between 1st January 2009 and 31st December 2023 with a diagnosis of spontaneous oesophageal rupture. Patients’ medical records were reviewed to confirm the diagnosis and collect data (patient demographics, investigations, management approach, 30-day mortality, length of hospital stay, and long-term outcomes). Results Thirty-eight patients were identified with Boerhaave’s syndrome in the study period, resulting in an incidence of 4.4 cases per year per million population. The median age at presentation was 50 years (range 16-83) and 14 (37%) were female. A CT scan confirmed the diagnosis in all cases. Twenty-four (63%) patients were managed non-operatively and 14 (37%) patients underwent operative management. No patients were managed with an endoscopic procedure. The mean length of stay was 12 and 35 days for patients managed non-operatively and operatively, respectively. The overall 30-day mortality rate was 13% (7% operative management and 17% non-operative management). Four patients were reported to develop long term morbidity following Boerhaave’s syndrome and the mean follow up was 6 months. Conclusions Boerhaave’s syndrome is a rare but serious condition with a significant mortality rate associated with it (13% at 30 days). In this study, most patients were managed non-operatively, however early surgery should be considered for patients with significant mediastinal and/or pleural contamination.