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Thirty-day outcomes in the operative management of intestinal-cutaneous fistulas: A NSQIP analysis

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  • Mathias A Christensen
  • Apostolos Gaitanidis
  • Jonathan Parks
  • April Mendoza
  • Noelle Saillant
  • Haytham M A Kaafarani
  • Peter Fagenholz
  • George Velmahos
  • Jason Fawley
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INTRODUCTION: Intestinal-cutaneous fistulas (ICFs) constitute a major surgical challenge. Definitive surgical treatment of ICFs continues to be associated with significant morbidity. The purpose of this study was to utilize a nationwide database to define the morbidity associated with current treatment strategies in the surgical management of ICFs.

METHODS: The 2006-2017 American College of Surgeon National Surgical Quality Improvement datasets (ACS-NSQIP) were used to assess 30-day morbidity and mortality after surgical repair of ICFs. Outcomes for emergent repair were compared to elective repair of ICFs.

RESULTS: Overall, 4197 patients undergoing ICF-repair were identified. Mean age was 55.9 (SD 15.3). Patients were generally comorbid (62.9% were in ASA class III). The observed in-hospital mortality was 2.3%. However, the observed morbidity rate was 47.3%. Of the observed morbidity, 35.6% was due to post-operative infectious complications (superficial surgical site infections (SSI), deep SSI, organ/space SSI, wound disruption, pneumonia, urinary tract infection (UTI) sepsis or septic shock). The most common infectious complication was sepsis (13.1%). 30-day readmission rate was 15.3% and the 30-day reoperation rate was 11.0%. Emergent repair was associated with a sevenfold increase in mortality (11.9% vs 1.8%, P < 0.001) CONCLUSION: The management of patients with ICFs is complex and is associated with significant morbidity. Half of patients undergoing surgical management of ICFs developed in-hospital complications.

Original languageEnglish
JournalAmerican Journal of Surgery
Volume221
Issue number5
Pages (from-to)1050-1055
Number of pages6
ISSN0002-9610
DOIs
Publication statusPublished - May 2021

    Research areas

  • Enterocutaneous fistula, Morbidity, Mortality, Outcomes

ID: 60874389