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. 2008 Nov 1;28(9):1111-21.
doi: 10.1111/j.1365-2036.2008.03819.x. Epub 2008 Jul 30.

An analysis of predictive factors for healing and mortality in patients with enterocutaneous fistulas

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An analysis of predictive factors for healing and mortality in patients with enterocutaneous fistulas

J E Mawdsley et al. Aliment Pharmacol Ther. .

Abstract

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.

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