BACKGROUND: Most studies of enterocutaneous fistula report management and outcome. Few studies examine factors predicting healing and mortality. AIM: To identify factors predicting healing and mortality in patients with ECF managed either with a definitive attempt at surgical closure or conservatively. METHODS: The case notes of 277 patients with enterocutaneous fistula, treated at our institution over a 10 year period, were retrospectively reviewed. Patients were divided into those managed operatively or conservatively. Eleven factors were examined for their relationship to fistula healing and fistula-related mortality. RESULTS: For patients treated operatively, successful enterocutaneous fistula closure related only to the complexity of the fistula (multiple fistula or presence of an internal abscess cavity) (P = 0.03), whereas fistula-related mortality related only to the presence of comorbidity (P = 0.02). In patients managed conservatively, a decreased likelihood of enterocutaneous fistula closure was associated with a high fistula output (P = 0.01), comorbidity (P = 0.03) and being referred from an external institution (P < 0.001). Fistula related-mortality in this group was related to a high output (P = 0.003) and an increased age (P = 0.001). CONCLUSION: In patients managed operatively, fistula healing and fistula-related mortality are each associated with only one factor, whereas in patients managed conservatively healing and mortality are predicted by three and two factors, respectively.
BACKGROUND: Most studies of enterocutaneous fistula report management and outcome. Few studies examine factors predicting healing and mortality. AIM: To identify factors predicting healing and mortality in patients with ECF managed either with a definitive attempt at surgical closure or conservatively. METHODS: The case notes of 277 patients with enterocutaneous fistula, treated at our institution over a 10 year period, were retrospectively reviewed. Patients were divided into those managed operatively or conservatively. Eleven factors were examined for their relationship to fistula healing and fistula-related mortality. RESULTS: For patients treated operatively, successful enterocutaneous fistula closure related only to the complexity of the fistula (multiple fistula or presence of an internal abscess cavity) (P = 0.03), whereas fistula-related mortality related only to the presence of comorbidity (P = 0.02). In patients managed conservatively, a decreased likelihood of enterocutaneous fistula closure was associated with a high fistula output (P = 0.01), comorbidity (P = 0.03) and being referred from an external institution (P < 0.001). Fistula related-mortality in this group was related to a high output (P = 0.003) and an increased age (P = 0.001). CONCLUSION: In patients managed operatively, fistula healing and fistula-related mortality are each associated with only one factor, whereas in patients managed conservatively healing and mortality are predicted by three and two factors, respectively.
Authors: Christopher Andrew Lamb; Nicholas A Kennedy; Tim Raine; Philip Anthony Hendy; Philip J Smith; Jimmy K Limdi; Bu'Hussain Hayee; Miranda C E Lomer; Gareth C Parkes; Christian Selinger; Kevin J Barrett; R Justin Davies; Cathy Bennett; Stuart Gittens; Malcolm G Dunlop; Omar Faiz; Aileen Fraser; Vikki Garrick; Paul D Johnston; Miles Parkes; Jeremy Sanderson; Helen Terry; Daniel R Gaya; Tariq H Iqbal; Stuart A Taylor; Melissa Smith; Matthew Brookes; Richard Hansen; A Barney Hawthorne Journal: Gut Date: 2019-09-27 Impact factor: 23.059
Authors: Fleur E E de Vries; Jeroen J M Claessen; Elina M S van Hasselt-Gooijer; Oddeke van Ruler; Cora Jonkers; Wanda Kuin; Irene van Arum; G Miriam van der Werf; Mireille J Serlie; Marja A Boermeester Journal: J Gastrointest Surg Date: 2020-07-22 Impact factor: 3.452
Authors: Ruben G J Visschers; Wim G van Gemert; Bjorn Winkens; Peter B Soeters; Steven W M Olde Damink Journal: World J Surg Date: 2012-10 Impact factor: 3.352