Soporte nutricional y factores de riesgo de aparición de fístulas enterocutáneas

Abstract

Introduction: Among the different factors described, nutritional support has been associated to prevention and management of enterocutaneous fistulae (ECF). Objectives: To assess the influence that the parameters related to nutritional, clinical status, and surgical variables have on the occurrence of ECF. Methods: An observational case/control retrospective study was performed on patients admitted to the General and Digestive Surgery Department. The parameters analyzed were: diagnosis, body mass index (BMI), pathologic personal history, number of surgical interventions (SI) and complications (previous infection, bleeding, and ischemia). In patients with SI, we analyzed: number and type of SI, time until onset of nutritional support, and type of nutritional support. We performed a multiple logistic uni- and multivariate regression analysis by using the SPSSv.19.0 software. Results: The primary diagnoses related to the occurrence of ECF were pancreatic pathology (OR = 5.346) and inflammatory bowel disease (IBD) (OR = 9.329). The surgical variables associated to higher prevalence of ECF emergency SI (OR = 5.79) and multiple SI (OR = 4.52). Regarding the nutritional variables, the late onset of nutrition (more than three days after SI) was associated to the occurrence of ECF (OR = 3.82). Conclusions: In surgical patients, early nutritional support , independently of the route of administration, decreases the occurrence of fistulae. Pancreatic pathology, IBD, emergency SI, and multiple SI were associated to higher prevalence of ECF. The variable hyponutrition appears as a risk factor that should be confirmed in further studies. (Nutr Hosp. 2012;27:213-218) DOI:10.3305/nh.2012.27.1.5405 Resumen Introduccion: Entre los diferentes factores descritos, el soporte nutricional se ha asociado a la prevencion y el tratamiento de las fistulas enterocutaneas (FEC). Objetivos: Evaluar la influencia que los parametros relacionados con variables nutricionales, estado clinico y quirurgicas tienen sobre la aparicion de FEC. Metodos: Se realizo un estudio retrospectivo observacional de casos/controles en pacientes ingresados en Cirugia General y Digestiva. Se analizaron: diagnostico, indice de masa corporal (IMC), antecedentes patologicos, numero de intervenciones quirurgicas (IQ) y complicaciones (infeccion previa, sangrado e isquemia). En los pacientes