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Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes
Jose L Martinez1, Enrique Luque-de-Leon, Juan Mier
1General and Gastrointestinal Surgery, Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc #330, Col. Doctores, Deleg. Cuauhtémoc, 06725 México, D.F, México. jlmo1968@yahoo.com
Insights
Postoperative enterocutaneous fistulas (PEF) often lead to complications. High output, jejunal site, multiple fistulas, and sepsis independently predict poor outcomes, including non-spontaneous closure and increased mortality.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Prognostic Factor Analysis
Background:
- Postoperative enterocutaneous fistulas (PEF) are a common surgical complication.
- PEF management is challenged by high rates of sepsis, malnutrition, and hydroelectrolytic deficit.
- Identifying prognostic factors is crucial for effective PEF treatment strategies.
Purpose of the Study:
- To identify factors influencing spontaneous closure, operative treatment necessity, and mortality in patients with PEF.
- To analyze prognostic indicators for various PEF outcomes.
- To inform therapeutic decision-making for PEF patients.
Main Methods:
- Retrospective review of 174 consecutive PEF patients over a 10-year period.
- Univariate and multivariate analyses were conducted to assess outcome predictors.
- Data collected included fistula origin, output, presence of sepsis, and nutritional status.
Main Results:
- Overall closure rate was 86% (37% spontaneous, 49% surgical).
- Factors precluding spontaneous closure included jejunal site, multiple fistulas, sepsis, high output, and hydroelectrolytic deficit.
- High output, jejunal site, multiple fistulas, and sepsis were independently associated with adverse outcomes (non-spontaneous closure, operative treatment, mortality).
Conclusions:
- Despite advances, PEF management continues to present significant morbidity and mortality.
- High output, jejunal fistula location, multiple fistulas, and sepsis are key independent adverse prognostic factors.
- These factors are critical for guiding treatment decisions and improving patient outcomes in PEF.
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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