Method for predicting the development of adverse events in the treatment of fine intestinal fistula

Larichev A. B., Efremov K. N., Shubin L. B., Gabibov I. K.

Relevance. The success of the treatment of small intestinal fistula largely depends on solving the issue of blocking the outflow of contents through it. The idea of using sandostatin or its analogues looks promising. However, in order to prove their effectiveness, it is important to understand the need for statistical objectification. Purpose: to detect predictors of adverse outcome in the treatment of fistula of the small intestine using modern methods of statistics. Materials and methods. The results of treatment of 69 patients with small intestinal fistula, who were in the surgical hospital of N.A. Semashko of Yaroslavl from 1988 to 2018. The comparison group included 41 patients with a traditional approach to treatment, the main group included 28 patients who used octreotide. Through a risk assessment procedure and weighing the chances, the probability of developing adverse outcomes was predicted: the need for surgical closure of the intestinal fistula (first model) and death (second model Results. With traditional treatment, the first model revealed from 24 to 37 predictors indicating the likelihood of the need for surgical elimination of the fistula. Against the background of octreotide, at the beginning of the study, the number of predictors was small, and by the end of the study, their complete regression was observed. In the second model with traditional tactics, a significant number of variables (from 11 to 19) indicated the probability of a fatal outcome. In the group with octreotide, such predictors were much fewer, which underlines its high effectiveness in reducing the predicted mortality. Conclusion. Statistical modeling allows an objective assessment of the process of treatment of small intestinal fistula, during which it is possible to identify significantly changing variables that have predictive value in relation to an unfavorable outcome. Using octreotide, even in the initial stages of treatment, the chances of death are reduced, and later the need for surgical intervention is leveled. This is confirmed by practical experience (mortality reduction by 2.3 times).

Keywords:small intestinal fistula, octreotide, multiple organ dysfunction, statistical modeling.