title: Treatment of Enterocutaneous Fistulas, Then and Now.
abstract: BACKGROUND
  An enterocutaneous fistula (ECF) is an aberrant connection between the gastrointestinal tract and the skin or atmosphere (enteroatmospheric fistula [EAF]). Multimodal treatment includes surgical procedures, nutrition support, and wound care. We evaluated our practice and compared our outcomes with previous results published from our institution.
  
  
  METHODS
  We performed a retrospective analysis of hospitalized ECF/EAF patients admitted between January 2011 and November 2015. Patients with internal fistulas; active inflammatory bowel disease; malignancy; radiation treatment; end-stage renal, hepatic, or cardiac disease; and active alcoholism were excluded. Data collected included demographics, fistula characteristics, nutrition therapy, treatment, operative success, and hospital mortality. Parametric and nonparametric tests for independent and paired groups were performed.
  
  
  RESULTS
  Thirty-one patients were included in the analysis. The median (interquartile range) age was 60 (53-76) years, and 81% were female. Parenteral nutrition was initially prescribed in 80% of patients, but 61% received enteral nutrition (EN) at some point during their hospitalization. Two patients were fed by fistuloclysis. Eighty percent of the patients underwent surgical repair a median of 12 months after diagnosis with 92% operative success. Surgical repair had a modest correlation with home discharge (ρ = 0.517, P = .003). A large proportion of patients (77%) were discharged home. The in-hospital mortality at our institution decreased from 44% in 1960 to 21% in 1970 to 3% in the current study.
  
  
  CONCLUSIONS
  Modern treatment of ECF/EAF, including EN and advanced local wound care, is associated with improvements in clinical outcomes such as hospital mortality.
authors.affiliation: 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA.
authors.forename: Luis Alfonso
authors.initials: LA
authors.lastname: Ortiz
authors.affiliation: 2 Massachusetts General Hospital, Department of Pharmacy, Boston, Massachusetts, USA.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: 3 Massachusetts General Hospital, Department of General Surgery, Boston, Massachusetts, USA.
authors.forename: Maureen Walsh
authors.initials: MW
authors.lastname: McCarthy
authors.affiliation: 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA.
authors.forename: Haytham M A
authors.initials: HMA
authors.lastname: Kaafarani
authors.affiliation: 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Fagenholz
authors.affiliation: 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: King
authors.affiliation: 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: De Moya
authors.affiliation: 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA.
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.affiliation: 1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA.
authors.forename: Daniel Dante
authors.initials: DD
authors.lastname: Yeh
mesh_terms: D000368:Aged; D004750:Enteral Nutrition / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007412:Intestinal Fistula / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000639:trends*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing
keywords: cutaneous fistula; enteral nutrition; enteroatmospheric fistulas; enterocutaneous fistula; fistula; fistuloclysis; intestinal fistula; parenteral nutrition