S. Boateng1, N. Kugler1, C. Trevino1 1Medical College Of Wisconsin,Surgery – Division Of Trauma & Critical Care,Milwaukee, WI, USA
Introduction: Enteric fistulae, an abnormal communication between the lumen of the gastrointestinal tract and the skin, are a devastating complication that can occur following abdominal surgery. Unfortunately, standardized care of these complex patients has not been implemented at the majority of tertiary hospitals. Thus we sought to evaluate the benefit of an evidence based clinical treatment protocol for enteric fistulae. We hypothesized that standardized treatment would increase spontaneous enteric fistulae closure rates and decrease hospital length of stay.
Methods: We conducted a retrospective review of patients with an enterocutaneous fistula managed by the Division of Trauma and Acute Care Surgery at a tertiary academic medical center. Patients managed prior to implementation of a standardized treatment protocol were considered the control group for those patients managed post protocol implementation. A review of all eligible patient’s hospital and clinic medical records was performed to obtain data collection. The primary outcome of the trial was time to successful non-operative closure. Secondary outcomes included compliance with all elements of the treatment protocol and inpatient length of stay. Inpatient length of stay was determined from time of fistula identification to discharge, for those transferred to our facility length of stay is from time of admission to our facility to discharge.
Results: A total of 18 patients with enterocutaneous fistula managed by the multidisciplinary team were identified over 4 1/2 years with six control patients identified over the first half of this time period. The control group patients had a spontaneous closure rate of 16.7% with four of the remaining five undergoing operative closure, one patient was not offered operative intervention due to extensive medical co-morbidities. The mean length of stay within the control group was 37.5 days (Range 16-67 days). Twelve patients were managed utilizing the protocol with a spontaneous closure rate of 83% noted within this cohort, the remaining two patients within this cohort required operative closure. The mean length of stay post protocol implementation was 13.8 days (Range 4-28 days).
Conclusion: Implementation of a enterocutaneous fistula management protocol focusing on multidisciplinary management provides significant advantages for patients through improved spontaneous closure rates and decreased hospital length of stay.