Major Risk Factors of Mortality in Adult and Elderly Patients Emergently Admitted for Intestinal Fistulas, Excluding the Rectum and Anus.

Introduction: In the United States, intestinal fistulas accounts for $500 million (USD) of healthcare expenditures and 28,000 admissions annually. They are also associated with significant morbidity and mortality. Despite the high prevalence of intestinal fistulas, risk factors of mortality have yet to be fully elucidated. The aim of this study was to identify risk factors of mortality in emergently admitted patients with fistulas of the intestine, excluding the rectum and anus.

Materials and methods: Adult and elderly patients emergently admitted with intestinal fistulas, between 2004-2014 were investigated using the National Inpatient Sample Database, ICD-9-CM code 569.81. Clinical outcomes, therapeutic management, demographics, and comorbidities were collected. Associations between mortality and all other variables were established via univariable and multivariable logistic regression models. The final multivariable regression model elucidated the odds ratios (95% confidence interval, p-value) of pertinent mortality risk factors.

Results: A total of 7,377 patients were included, of which the average adult and elderly ages were 48.9 and 74.6 years, respectively. Of these patients, 4,241 (57.5%) were female and 3,136 (42.5%) were male. Elderly patients demonstrated a higher mortality rate than adult patients-4.5% and 1.7%, respectively. In the adult group, the odds ratio for mortality was 1.020 for hospital length of stay in days (95% CI: 1.015-1.026, p<0.001), 1.035 for age (95% CI: 1.011-1.060, p=0.004), and 1.033 for days to the first procedure (95% CI: 1.021-1.044, p<0.001), among others. For the elderly group, the odds ratio for mortality was 1.012 for hospital length of stay in days (95% CI: 1.005-1.019, p=0.001), 1.075 for age (95% CI: 1.050-1.101, p<0.001), and 1.026 for days to the first procedure (95% CI: 1.009-1.043, p=0.002), among others.

Conclusion: In adult and elderly patients emergently admitted for intestinal fistulas, multiple comorbidities were risk factors for in-hospital mortality. In the elderly cohort, increased age and increased days to operation were additional risk factors for in-hospital mortality.