Risk factor analysis of enterocutaneous fistula after small bowel surgery

Abstract: Background: ECF most frequently follows a complication of abdominal surgery, although a smaller number occur spontaneously in association with conditia Background: Enterocutaneous fistula (ECF) most frequently follows a complication of abdominal surgery, although a smaller number occur spontaneously in association with conditions such as inflammatory bowel disease or malignancy. It ranks right up there in the list of most disappointing experiences for both the surgeon and the physician. The current study was aimed at identifying the risk factors of ECF formation after small bowel surgery. Methods: This prospective study was conducted in the Department of Surgery of Shaheed Ziaur Rahman Medical College and Hospital (SZRMCH), Bogura, Bangladesh from January 2015 to January 2017 over a period of 24 months. All the patients who underwent small bowel surgery in the Department of Surgery of SZRMCH during the study period after fulfilling the inclusion and exclusion criteria well included in the study. Logistic regression analysis was performed to assess the independent relationship between the factors. A p value <0.05 was considered to be significant. Results: A total number of 150 patients were enrolled in the current study. Among them, 15 patients (10%) developed ECF following small bowel surgery. 38% of the patients were in the age group of 21-30 years of age with a mean of 31.88±10.30 years. Majority (n=120) were males with a male female ratio of 4:1. Traumatic gut perforation (50.00%) was the most prevalent cause of admission followed by typhoid ulcer (24%) and tubercular ulcer perforation (20%) among the emergency cases (n=100). Intestinal obstruction due to malignancy (n=18) and inflammatory bowel disease (n=14) were the common causes of small bowel surgery in elective cases (50 cases). Univariate analysis showed presence of female sex, age >50 years, diabetes mellitus (DM), anaemia, hypoalbuminemia, malignancy, IBD, Tuberculosis, emergency surgery, jejunal surgery risk factors for post-operative ECF formation. Conclusions: The current study demonstrated hypoalbuminemia, emergency surgery and inflammatory bowel disease is an independent predictor of post-operative ECF development after small intestinal surgery. All surgeon should consider these predictors while performing small intestinal surgery in order to prevent postsurgical ECF. ons such as inflammatory bowel disease or malignancy. It ranks right up there in the list of most disappointing experiences for both the surgeon and the physician. The current study was aimed at identifying the risk factors of ECF formation after small bowel surgery. Materials and Methods: This prospective study was conducted in the Department of Surgery of Shaheed Ziaur Rahman Medical College and Hospital (SZRMCH), Bogura, Bangladesh from January 2015 to January 2017 over a period of 24 months. All the patients who underwent small bowel surgery in the Department of Surgery of SZRMCH during the study period after fulfilling the inclusion and exclusion criteria well included in the study. Logistic regression analysis was performed to assess the independent relationship between the factors. A p value < 0.05 was considered to be significant. Results: A total number of 150 patients were enrolled in the current study. Among them, 15 patients (10%) developed ECF following small bowel surgery. 38% of the patients were in the age group of 21-30 years of age with a mean of 31.88 ± 10.30 years. Majority (n=120) were males with a male female ratio of 4:1. Traumatic gut perforation (50.00%) was the most prevalent cause of admission followed by typhoid ulcer (24%) and tubercular ulcer perforation (20%) among the emergency cases (n=100). Intestinal obstruction due to malignancy (n=18) and inflammatory bowel disease (n=14) were the common causes of small bowel surgery in elective cases (50 cases). Univariate analysis showed presence of female sex, age>50 years, diabetes mellitus (DM), anaemia, hypoalbuminemia, malignancy, IBD, Tuberculosis, emergency surgery, jejunal surgery risk factors for post-operative ECF formation. However multivariate analysis demonstrated hypoalbuminemia, IBD, emergency surgery were independent predictors of ECF formation after small bowel surgery (p<0.05). Conclusion: The current study demonstrated hypoalbuminemia, emergency surgery and inflammatory bowel disease is an independent predictor of post-operative ECF development after small intestinal surgery. All surgeon should considered these predictors while performing small intestinal surgery in order to prevent postsurgical ECF. Keywords: Risk factors, enterocutanous fistula, small bowel surgery