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Updated: Dec 26, 2025
Colonial Wig Pancreaticojejunostomy
Published on: March 12, 2019
Enterocutaneous fistula after emergency general surgery: Mortality, readmission, and financial burden
Justin S Hatchimonji1, Jesse Passman, Elinore J Kaufman
1From the Department of Surgery (J.S.H., J.P., C.E.S.), Division of Traumatology, Surgical Critical Care and Emergency Surgery (E.J.K., D.S., D.N.H.), College of Arts and Sciences (L.W.M.), Department of General Internal Medicine (R.X.), and Center for Clinical Epidemiology and Biostatistics (D.N.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Background:
The burden of enterocutaneous fistula (ECF) after emergency general surgery (EGS) has not been rigorously characterized. We hypothesized that ECF would be associated with higher rates of postdischarge mortality and readmissions.
Methods:
Using the 2016 National Readmission Database, we conducted a retrospective study of adults presenting for gastrointestinal (GI) surgery. Cases were defined as emergent if they were nonelective admissions with an operation occurring on hospital day 0 or 1. We used International Classification of Diseases, 10th Revision, code K63.2 (fistula of intestine) to identify postoperative fistula. We measured mortality rates and 30- and 90-day readmission rates censuring discharges occurring in December or from October to December, respectively.
Results:
A total of 135,595 patients underwent emergency surgery; 1,470 (1.1%) developed ECF. Mortality was higher in EGS patients with ECF than in those without (10.1% vs. 5.4%; odds ratio [OR], 1.99; 95% confidence interval [CI], 1.67-2.36) among patients who survived the index admission. Readmission rates were higher for EGS patients with ECF than without at 30 days (31.0% vs. 12.6%; OR, 3.12; 95% CI, 2.76-3.54) and at 90 days (51.1% vs. 20.1%; OR, 4.15; 95% CI, 3.67-4.70). Similar increases were shown in elective GI surgery.
Conclusions:
Enterocutaneous fistula after GI EGS is associated with significantly increased odds of mortality and readmission, with rates continuing to climb out to at least 90 days. Processes of care designed to mitigate risk in this high-risk cohort should be developed.
Level Of Evidence:
Prognostic and Epidemiological Study, Level III.
