Enterocutaneous fistula after emergency general surgery: Mortality, readmission, and financial burden. J Trauma Acute Care Surg 2020 Jul;89(1):167-172
Date
03/17/2020Pubmed ID
32176165Pubmed Central ID
PMC7802884DOI
10.1097/TA.0000000000002673Scopus ID
2-s2.0-85088555142 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
BACKGROUND: The burden of enterocutaneous fistula (ECF) after emergency general surgery (EGS) has not been rigorously characterized. We hypothesized that ECF would be associated with higher rates of postdischarge mortality and readmissions.
METHODS: Using the 2016 National Readmission Database, we conducted a retrospective study of adults presenting for gastrointestinal (GI) surgery. Cases were defined as emergent if they were nonelective admissions with an operation occurring on hospital day 0 or 1. We used International Classification of Diseases, 10th Revision, code K63.2 (fistula of intestine) to identify postoperative fistula. We measured mortality rates and 30- and 90-day readmission rates censuring discharges occurring in December or from October to December, respectively.
RESULTS: A total of 135,595 patients underwent emergency surgery; 1,470 (1.1%) developed ECF. Mortality was higher in EGS patients with ECF than in those without (10.1% vs. 5.4%; odds ratio [OR], 1.99; 95% confidence interval [CI], 1.67-2.36) among patients who survived the index admission. Readmission rates were higher for EGS patients with ECF than without at 30 days (31.0% vs. 12.6%; OR, 3.12; 95% CI, 2.76-3.54) and at 90 days (51.1% vs. 20.1%; OR, 4.15; 95% CI, 3.67-4.70). Similar increases were shown in elective GI surgery.
CONCLUSIONS: Enterocutaneous fistula after GI EGS is associated with significantly increased odds of mortality and readmission, with rates continuing to climb out to at least 90 days. Processes of care designed to mitigate risk in this high-risk cohort should be developed.
LEVEL OF EVIDENCE: Prognostic and Epidemiological Study, Level III.
Author List
Hatchimonji JS, Passman J, Kaufman EJ, Sharoky CE, Ma LW, Scantling D, Xiong R, Holena DNAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Digestive System Surgical Procedures
Emergencies
Female
Humans
Intestinal Fistula
Male
Middle Aged
Patient Readmission
Postoperative Complications
Retrospective Studies