DELAYED ENTEROCUTANEOUS FISTULA TAKEDOWN IS A RISK FACTOR FOR POST-OPERATIVE NECROTIZING SOFT TISSUE INFECTION

Author(s):
Marlon Torres; Rohit Rasane; Christopher Horn; Adrian Coleoglou Centeno; Qiao Zhang; Kelly Marie Bochicchio; Obeid Ilahi; John Mazuski; Grant Bochicchio

Background:

Enterocutaneous fistula (ECF) is a challenging surgical disease to manage in part due to its devastating complications. Necrotizing soft tissue infections (NSTIs) of the abdominal wall are uncommon in the setting of ECF takedowns. There is a paucity of data evaluating the factors that contribute to the development of abdominal wall NSTI in ECF takedowns.

Hypothesis:

We hypothesize that delayed ECF takedown increases the probability of postoperative abdominal wall NSTIs.

Methods:

Prospective data were collected on all patients who underwent ECF takedown. We defined early takedown as ECF takedown within one year of diagnosis and late takedown as takedown after one year. Demographics, length of stay, comorbidities, (LOS), ICU length of stay (ICU LOS), mortality and postoperative complications were collected. We applied Student’s T-test for continuous variables and chi-squared for categorical variables.

Results:

We identified 75 patients who underwent ECF takedown, of which 38 (50.7%) patients had an early takedown and 37 (49.3%) had a late takedown. Patients who underwent ECF takedown had a mean age of 53.7 (+/- 14.3). ECF takedown was most commonly performed in females 41(54.7%), and Caucasians 54 (72.0%). Patients who underwent late ECF takedown had a significantly higher rate of abdominal wall NSTIs than in the early takedown cohort (21.6 vs 5.3%p=0.05). There was no difference found in age, gender, race, body mass index (BMI), LOS, ICU LOS and Charlson comorbidity index between groups.

Conclusions:

Patients who had a late ECF takedown were at a greater risk for developing postoperative abdominal wall NSTIs compared to those who underwent early ECF takedown. Therefore, earlier takedown should be considered for patients who develop ECF.  Further research is necessary to better understand this complex surgical complication.