Ceppa, DuyKhanh P.Rosati, Carlo MariaChabtini, LolaStokes, Samantha M.Cook, Holly C.Rieger, Karen M.Birdas, Thomas J.Lappas, John C.Kessler, William R.DeWitt, John M.Maglinte, Dean D.Kesler, Kenneth A.2018-02-092018-02-092017-09Ceppa, D. P., Rosati, C. M., Chabtini, L., Stokes, S. M., Cook, H. C., Rieger, K. M., … Kesler, K. A. (2017). Development of a Multidisciplinary Program to Expedite Care of Esophageal Emergencies. The Annals of Thoracic Surgery, 104(3), 1054–1061. https://doi.org/10.1016/j.athoracsur.2017.03.023https://hdl.handle.net/1805/15176Background Level 1 programs have improved outcomes by expediting the multidisciplinary care of critically ill patients. We established a novel level 1 program for the management of esophageal emergencies. Methods After institutional review board approval, we performed a retrospective analysis of patients referred to our level 1 esophageal emergency program from April 2013 through November 2015. A historical comparison group of patients treated for the same diagnosis in the previous 2 years was used. Results Eighty patients were referred and transported an average distance of 56 miles (range, 1–163 miles). Median time from referral to arrival was 2.4 hours (range, 0.4-12.9 hours). Referrals included 6 (7%) patients with esophageal obstruction and 71 (89%) patients with suspected esophageal perforation. Of the patients with suspected esophageal perforation, causes included iatrogenic (n = 26), Boerhaave’s syndrome (n = 32), and other (n = 13). Forty-six percent (n = 33) of patients were referred because of pneumomediastinum, but perforation could not be subsequently demonstrated. Initial management of patients with documented esophageal perforation included operative treatment (n = 25), endoscopic intervention (n = 8), and supportive care (n = 5). Retrospective analysis demonstrated a statistically significant difference in mean Pittsburgh severity index score (PSS) between esophageal perforation treatment groups (p < 0.01). In patients with confirmed perforations, there were 3 (8%) mortalities within 30 days. More patients in the esophageal level 1 program were transferred to our institution in less than 24 hours after diagnosis than in the historical comparison group (p < 0.01). Conclusions Development of an esophageal emergency referral program has facilitated multidisciplinary care at a high-volume institution, and early outcomes appear favorable.enPublisher Policyesophageal emergenciesesophageal perforationobstruction emergencyArticle