Outcomes of gastrointestinal fistulas: Results from a multi-continent, multi-national, multi-center cohort

SUMMARY Rationale Gastrointestinal fistulas (GIF) represent a severe and potentially lethal complication of the hospital surgical activity. However, evidences are lacking about prognosis and outcomes of GIF in Latin America (LATAM) hospitals. Objective To describe the prognosis and outcomes GIF in LATAM hospitals. Study design Prospective, longitudinal, cohort-type study. The cohort fostered three cross-sectional examinations: First examination: On admission of the patient in the study; Second examination: Thirty days later; and Third (and last) examination: Sixty days after patient’s admission. Study serie One hundred seventy-seven patients ( Males : 58.2 %; Average age : 51.0 ± 16.7 years; Ages ≥ 60 years: 36.2 %) diagnosed with, and assisted for, GIF (ECF: Enterocutaneous: 64.9 % vs . EAF: Enteroathmospheric: 35.1 %) in 76 LATAM hospitals (13 countries) and Europe (4). Methods Condition (Alive vs . Deceased) and hospital status (Hospitalized vs . Discharged) of the patient, and the GFI patency (Closed vs . Non closed) were recorded in each of the cohort’s examination. Indicators of GFI prognosis thus constructed were correlated demographical, sanitary, surgical and nutritional characteristics of the patients Results On conclusion of the study indicators of GIF prognosis behaved as follows: Mortality :14.7 %; Prolonged hospitalization : 47.4 %; Spontaneous closure of GIF : 36.2 %. Type of GIF influenced upon patient’s survival: ECF : 87.0 % vs. EAF : 82.3 % (Δ = +4.7 %; χ 2 = 6.787; p < 0.05). In each examination of the cohort, the number of surviving subjects was always greater among those with ECF: After 30 days : ECF: 92.1 % vs. EAF: 83.9 % (Δ = +8.2 %); After 60 days : ECF: 98.1 % vs. EAF: 90.4 % (Δ = +7.7 %; χ 2 = 13.764; p < 0.05). On the other hand, hospital stay was prolonged in the subjects of elective surgery ( Elective surgery : 61.4 % vs. Emergency surgery : 38.3 % (Δ = +23.1 %; χ 2 = 9.064; p < 0.05) and those with a reduced calf circumference ( χ 2 = 12.655; p < 0.05). Location of the fistula also influenced upon prolongation of hospital stay ( χ 2 = 7.817; p < 0.05). Conclusions Type of GIF influences upon survival of the patient. On the hand, hospital stay was dependent upon type of surgery previously performed, location of the fistula, and calf circumference value on admission in the study serie.