Epidemiology and outcome of patients with postoperative abdominal fistula

Abstract

A B S T R A C TObjective: to present the epidemiological profile, incidence and outcome of patients who developing postoperative abdominal fistula. Methods: This observational, cross-sectional, prospective study evaluated patients undergoing abdominal surgery. We studied the epidemiological profile, the incidence of postoperative fistulas and their characteristics, the outcome of this complication and the predictors of mortality. Results: The sample consisted of 1,148 patients. The incidence of fistula was 5.5%. There was predominance of biliary fistula (26%), followed by colonic fistulas (22%) and stomach (15%). The average time to onset of fistula was 6.3 days. For closure, the average was 25.6 days. The mortality rate of patients with fistula was 25.4%. Predictors of mortality in patients who developed fistula were age over 60 years, presence of comorbidities, fistula closure time more than 19 days, no spontaneous closure of the fistula, malnutrition, sepsis and need for admission to the Intensive Care Unit . Conclusion: abdominal postoperative fistulas are still relatively frequent and associated with significant morbidity and mortality.

Successful nonoperative management of high output enterocutaneous fistulae in high surgical risk HIV‐positive patients: Two case reports and literature review

“…Enterocutaneous fistula (ECF) is the most feared complication of abdominal surgery because of the associated morbidity and mortality rates. High mortality rates of 25.4% have been reported, mainly from sepsis, malnutrition, and electrolyte imbalance. The etiology of ECF in HIV infected patients is similar to the noninfected patients.…”

“…The diagnosis of ECF is usually obvious with external drainage of enteric contents. Typically, ECF presents postoperatively on day 5 or 6 with abdominal pain, fever, and prolonged ileus followed by drainage of fluid from the suture line . A diagnosis of surgical site infection is initially made but removal of one or two sutures results in the drainage of enteric contents.…”

“…Enterocutaneous fistula (ECF) is the most feared complication of abdominal surgery because of the associated morbidity and mortality rates. High mortality rates of 25.4% have been reported, 15 during abdominal surgery is by far the most common cause of ECF 16,17 though spontaneous fistula has been reported in HIV infected patients. 2 The majority of fistula follow emergency abdominal surgery.…”

The impact of enteric fistulas on US hospital systems

“…Most studies are based on a small series of patients, often from a single institution and describe treatment, etiology or complications of fistulas. 1,2 The trauma literature provides some data on the incidence of post trauma enteroatmospheric fistulas, 3e6 but this data does not include fistulas occurring after elective surgery or patients presenting with spontaneous fistulas. A number of studies have investigated EF in patients with Crohn's Disease, but neglect other benign or iatrogenic etiologies.…”

Drain site enterocutaneous fistula after hyperthermic intraperitoneal chemotherapy

“…The prevalence of enterocutaneous fistulas in the general population is not known. However, postoperative prevalence of enterocutaneous fistulas is 1.5% for trauma, 1 3.6% for general surgery, 2 and 15–35% for patients with Crohn's disease 3 . The latter is the most common cause of spontaneous fistulas.…”