Enterocutaneous fistula complicating trauma laparotomy: A major resource burden

Pedro G R Teixeira, Kenji Inaba, Joseph Dubose, Ali Salim, Carlos Brown, Peter Rhee, Timothy Browder, Demetrios Demetriades

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Enterocutaneous fistula (ECF) is an uncommon and poorly studied postoperative complication. The objective of this study was to analyze the incidence and resource utilization of patients who developed an ECF after trauma laparotomy. All patients with an ECF occurring after trauma laparotomy at a Level I trauma center were identified through a review of both the Trauma Registry and the Morbidity and Mortality reports for a 9-year period ending in December 2006. Each ECF case was matched with a control (non-ECF) that did not develop this complication after laparotomy. The matching criteria were: age, gender, mechanism of injury, Injury Severity Score, Abbreviated Injury Score, and damage control laparotomy requiring an open abdomen. Outcomes analyzed were intensive care unit (ICU) and hospital length of stay, mortality, and total hospital charges. During the 9-year period, of 2373 acute trauma laparotomies performed, 36 (1.5%) patients developed an enterocutaneous fistula, and were matched to 36 controls. Patients with an ECF were 31 ± 12 years of age, were 97 per cent male, had a mean Injury Severity Score of 21 ± 10, and 75 per cent were penetrating. Eighty-nine per cent of the ECF patients had a hollow viscus injury. The most common was colon (69%), followed by small bowel (53%), duodenum (36%), and stomach (19%). Fifty-six per cent of the ECF patients had multiple hollow viscus injuries. The development of an ECF was associated with significantly increased ICU length of stay (28.5 ± 30.5 vs 7.6 ± 9.3 days, P = 0.004), hospital length of stay (82.1 ± 100.8 vs 16.2 ± 17.3 days, P < 0.001), and hospital charges ($539,309 vs $126,996, P < 0.001). In conclusion, the development of an enterocutaneous fistula after laparotomy for trauma resulted in a significant impact on resource utilization including longer ICU and hospital length of stay and higher hospital charges. Further investigation into the prevention and treatment of this costly complication is warranted.

Original languageEnglish (US)
Pages (from-to)30-32
Number of pages3
JournalAmerican Surgeon
Volume75
Issue number1
StatePublished - Jan 2009

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Intestinal Fistula
Laparotomy
Length of Stay
Wounds and Injuries
Hospital Charges
Intensive Care Units
Injury Severity Score
Viscera
Mortality
Trauma Centers
Duodenum
Abdomen
Fistula
Registries
Stomach
Colon
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Teixeira, P. G. R., Inaba, K., Dubose, J., Salim, A., Brown, C., Rhee, P., ... Demetriades, D. (2009). Enterocutaneous fistula complicating trauma laparotomy: A major resource burden. American Surgeon, 75(1), 30-32.

Enterocutaneous fistula complicating trauma laparotomy : A major resource burden. / Teixeira, Pedro G R; Inaba, Kenji; Dubose, Joseph; Salim, Ali; Brown, Carlos; Rhee, Peter; Browder, Timothy; Demetriades, Demetrios.

In: American Surgeon, Vol. 75, No. 1, 01.2009, p. 30-32.

Research output: Contribution to journalArticle

Teixeira, PGR, Inaba, K, Dubose, J, Salim, A, Brown, C, Rhee, P, Browder, T & Demetriades, D 2009, 'Enterocutaneous fistula complicating trauma laparotomy: A major resource burden', American Surgeon, vol. 75, no. 1, pp. 30-32.
Teixeira PGR, Inaba K, Dubose J, Salim A, Brown C, Rhee P et al. Enterocutaneous fistula complicating trauma laparotomy: A major resource burden. American Surgeon. 2009 Jan;75(1):30-32.
Teixeira, Pedro G R ; Inaba, Kenji ; Dubose, Joseph ; Salim, Ali ; Brown, Carlos ; Rhee, Peter ; Browder, Timothy ; Demetriades, Demetrios. / Enterocutaneous fistula complicating trauma laparotomy : A major resource burden. In: American Surgeon. 2009 ; Vol. 75, No. 1. pp. 30-32.
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abstract = "Enterocutaneous fistula (ECF) is an uncommon and poorly studied postoperative complication. The objective of this study was to analyze the incidence and resource utilization of patients who developed an ECF after trauma laparotomy. All patients with an ECF occurring after trauma laparotomy at a Level I trauma center were identified through a review of both the Trauma Registry and the Morbidity and Mortality reports for a 9-year period ending in December 2006. Each ECF case was matched with a control (non-ECF) that did not develop this complication after laparotomy. The matching criteria were: age, gender, mechanism of injury, Injury Severity Score, Abbreviated Injury Score, and damage control laparotomy requiring an open abdomen. Outcomes analyzed were intensive care unit (ICU) and hospital length of stay, mortality, and total hospital charges. During the 9-year period, of 2373 acute trauma laparotomies performed, 36 (1.5{\%}) patients developed an enterocutaneous fistula, and were matched to 36 controls. Patients with an ECF were 31 ± 12 years of age, were 97 per cent male, had a mean Injury Severity Score of 21 ± 10, and 75 per cent were penetrating. Eighty-nine per cent of the ECF patients had a hollow viscus injury. The most common was colon (69{\%}), followed by small bowel (53{\%}), duodenum (36{\%}), and stomach (19{\%}). Fifty-six per cent of the ECF patients had multiple hollow viscus injuries. The development of an ECF was associated with significantly increased ICU length of stay (28.5 ± 30.5 vs 7.6 ± 9.3 days, P = 0.004), hospital length of stay (82.1 ± 100.8 vs 16.2 ± 17.3 days, P < 0.001), and hospital charges ($539,309 vs $126,996, P < 0.001). In conclusion, the development of an enterocutaneous fistula after laparotomy for trauma resulted in a significant impact on resource utilization including longer ICU and hospital length of stay and higher hospital charges. Further investigation into the prevention and treatment of this costly complication is warranted.",
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