Faculty Collaboration Database

Enteric Fistula Treatment and Management: Results of an Institutional Inpatient Treatment Protocol. WMJ 2019 Jul;118(2):75-79

Date

09/19/2019

Pubmed ID

31532932

Scopus ID

2-s2.0-85072376176 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

INTRODUCTION: Enterocutaneous fistulae (ECF) are abnormal communications between the gastrointestinal tract and skin that may occur following an abdominal operation and result in significant morbidity and even mortality. Standardized care of patients with ECF has not been implemented at the majority of tertiary hospitals. We sought to evaluate the benefits of a multidisciplinary team utilizing an evidence-based clinical treatment protocol for inpatient management of ECF.

METHODS: We performed an Institutional Review Board-approved retrospective analysis of outcomes after the implementation of an evidence-based clinical treatment protocol for patients admitted with ECF to the acute care surgical service at a large academic medical facility. Patients managed prior to the established protocol were considered part of the pre-protocol cohort (pre) while patients managed following implementation were included in the postprotocol cohort (post). A review of all eligible patients' hospital and clinic medical records was performed.

RESULTS: In the pre cohort (n = 6), the average length of stay was 37 days, ranging from 16-67 days, with a 16% spontaneous closure rate and 60% requiring operative management for closure. A single patient was not offered surgery due to significant comorbidities. The post cohort (n = 13) demonstrated an average length of stay of just 16 days, ranging from 4 to 28 days, with an 84% spontaneous closure rate and 16% requiring operative closure.

CONCLUSION: Utilization of a standardized treatment approach results in high spontaneous closure rates with a decreased hospital length of stay.

Author List

Kugler NW, Boateng S, Webb TP, Trevino CM

Authors

Nathan W. Kugler MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Colleen Trevino PhD APP Clinical Dir Inpatient 2 in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Clinical Protocols
Evidence-Based Medicine
Female
Humans
Inpatients
Intestinal Fistula
Length of Stay
Male
Middle Aged
Retrospective Studies