Enterocutaneous fistulas: treatment outcomes and risk factors for persistence-a multicenter retrospective study

Abstract

Enterocutaneous fistulas (ECFs) present significant challenges due to their high morbidity and mortality. This multicenter retrospective study investigates factors influencing treatment outcomes in patients with ECFs.MethodsA total of 125 patients treated for ECFs between 2005 and 2021 across five high-volume university hospitals were analyzed. Patients younger than 18 years, those with perianal or upper gastrointestinal fistulas, and those with incomplete records were excluded. Patient demographics, comorbidities, fistula characteristics, and treatment modalities were evaluated. Fistula output was classified as high, moderate or low. Surgical and nonsurgical outcomes were compared, and independent risk factors for fistula persistence were identified using multivariate analysis.ResultsThe mean age was 54.1 +/- 16.4 years, and 45.6% of patients were female. The most common fistula origin was the ileum (40.8%). Closure rates were higher in the surgical group (81.2%) than in the nonsurgical group (63.6%). High-output fistulas had a higher mortality rate (20%) compared to moderate- (11.8%) and low-output (2.8%) fistulas. Inflammatory bowel disease (odds ratio [OR] = 5.40, 95% confidence interval [CI] 1.36-21.34) and high fistula output (OR = 3.81, 95% CI 1.30-11.15) were significant predictors of persistence.ConclusionA multidisciplinary approach is essential for optimizing ECF outcomes. Future research should refine treatment protocols and explore novel therapies, particularly for high-output fistulas and complex cases.