Outcomes of Gastrointestinal Fistulas: Results from a Multi-Continent, Multi-National Multi-Center Cohort

Abstract

Humberto Arenas Marquez*, Maria Isabel Turcios Correia, Juan Francisco Gracia, Roberto Anaya Prado, Arturo Vergara and Alejandra Cacho

Rationale: Gastro Intestinal Fistulas (GIF) represents 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: 1st examination: On admission of the patient in the study; 2nd examination: Thirty days later; and 3rd (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 with 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%; χ²=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%;χ²2=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%; Δ2=9.064; p<0.05) and those with a reduced calf circumference (χ²=12.655; p<0.05). Location of the fistula also influenced upon prolongation of hospital stay (χ²=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.