Systematic Management of Postoperative Enterocutaneous Fistulas: Factors Related to Outcomes |
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Authors: | Soumitra R Eachempati |
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Institution: | (1) Department of Surgery and Public Health, Weill Medical College of Cornell University, 525 E. 68th Street, New York, New York 10021, USA |
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Abstract: | Background Most enterocutaneous fistulas are postoperative in origin. Sepsis, malnutrition, and hydroelectrolytic deficit are still the
most important complications to which patients with postoperative enterocutaneous fistulas (PEF) are exposed. Knowledge of
prognostic factors related to specific outcomes is essential for therapeutic decision-making processes.
Methods We reviewed files of all consecutive patients with PEF treated in our hospital during a 10-year period. Our aim was to identify
factors related to spontaneous closure, need for operative treatment, and mortality. Univariate and multivariate analyses
were performed.
Results A total of 174 patients were treated. The most frequent site of origin was the small bowel (90 patients: 48 jejunal, and 42
ileal), followed in frequency by the colon (50 patients). Postoperative enterocutaneous fistula closure was achieved in 151
patients (86%), being spontaneous in 65 (37%) and surgical in 86 (49%). Factors that significantly precluded spontaneous closure
were jejunal site, multiple fistulas, sepsis, high output, and hydroelectrolytic deficit at diagnosis or referral. Origin
of PEF at our hospital was the only factor significantly associated with spontaneous closure. The most frequent operative
indication was PEF persistence without sepsis. Factors significantly associated with the need for operative treatment were
high output, jejunal site, and multiple fistulas. Closure was achieved in 84% of patients who underwent operation. A total
of 23 patients died (13%). Factors associated with mortality were serum albumin <3.0 g/dl (at diagnosis or referral), high
output, hydroelectrolytic deficit, multiple fistulas, jejunal site, sepsis, and a complex fistulous tract.
Conclusions In spite of advances in management of PEF, the associated morbidity and mortality remain high. Among several variables influencing
outcome, our multivariate analysis disclosed high output, jejunal site, multiple fistulas, and sepsis as independent adverse
factors related to non-spontaneous closure, need for operative treatment, and/or death. |
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