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

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.