title: An analysis of predictive factors for healing and mortality in patients with enterocutaneous fistulas.
abstract: BACKGROUND
  Most studies of enterocutaneous fistula report management and outcome. Few studies examine factors predicting healing and mortality.
  
  
  OBJECTIVE
  To identify factors predicting healing and mortality in patients with ECF managed either with a definitive attempt at surgical closure or conservatively.
  
  
  METHODS
  The case notes of 277 patients with enterocutaneous fistula, treated at our institution over a 10 year period, were retrospectively reviewed. Patients were divided into those managed operatively or conservatively. Eleven factors were examined for their relationship to fistula healing and fistula-related mortality.
  
  
  RESULTS
  For patients treated operatively, successful enterocutaneous fistula closure related only to the complexity of the fistula (multiple fistula or presence of an internal abscess cavity) (P = 0.03), whereas fistula-related mortality related only to the presence of comorbidity (P = 0.02). In patients managed conservatively, a decreased likelihood of enterocutaneous fistula closure was associated with a high fistula output (P = 0.01), comorbidity (P = 0.03) and being referred from an external institution (P < 0.001). Fistula related-mortality in this group was related to a high output (P = 0.003) and an increased age (P = 0.001).
  
  
  CONCLUSIONS
  In patients managed operatively, fistula healing and fistula-related mortality are each associated with only one factor, whereas in patients managed conservatively healing and mortality are predicted by three and two factors, respectively.
authors.affiliation: Lennard-Jones Intestinal Failure Unit, St Mark's Hospital, Harrow, London, UK. joelmawdsley@yahoo.com
authors.forename: J E
authors.initials: JE
authors.lastname: Mawdsley
authors.forename: P
authors.initials: P
authors.lastname: Hollington
authors.forename: P
authors.initials: P
authors.lastname: Bassett
authors.forename: A J
authors.initials: AJ
authors.lastname: Windsor
authors.forename: A
authors.initials: A
authors.lastname: Forbes
authors.forename: S M
authors.initials: SM
authors.lastname: Gabe
mesh_terms: D000328:Adult; D005544:Forecasting; D006801:Humans; D007412:Intestinal Fistula / Q000401:mortality* / Q000628:therapy; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D012189:Retrospective Studies; D013223:Statistics as Topic; D014945:Wound Healing / Q000502:physiology*