Vesicovaginal fistulas in the developed world: An analysis of disease characteristics, treatments, and complications of surgical repair using the ACS-NSQIP database

Marissa C. Theofanides, Wilson Sui, Elisabeth M. Sebesta, Ifeanyi Onyeji, Justin T. Matulay, Doreen E. Chung

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Aims: To analyze patient characteristics, complications, and surgical trends in vesicovaginal fistulas (VVF) from a national database. Methods: Current Procedural Terminology was used to identify patients undergoing VVF repair from the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database. Characteristics and treatments were identified. Logistic regression was used to identify characteristics associated with complications. Results: From 2006 to 2013, 200 patients underwent VVF repair. Mean age was 50.3 ± 12.3 years. A large proportion of patients were overweight (72%) and recent smokers (30%). Predominant comorbidities were heart disease (29%) and type 2 diabetes (9.5%). Of all VVF repairs, 65% were repaired vaginally. Concomitant procedures included hysterectomy (n = 6), reconstructive flaps (n = 13), and slings (n = 2). Post-operative complications occurred in 15% of patients. The most common complication was urinary tract infection (8%) followed by blood transfusion (3%). Compared to the vaginal approach, abdominal VVF repairs had higher overall morbidity (22% vs 7% P = 0.003), longer length of stay (3.5 ± 2.3 vs 1.6 ± 2 days P = 0.00) and were more likely to be associated with sepsis (4.3% vs 0% P = 0.02), blood transfusion (7.1% vs 0.8% P = 0.017), and readmission (10.1% vs 0.8% P = 0.003). In multivariate analysis, abdominal approach was a significant predictor of complications within 30 days (P = 0.03, P = 0.02). Conclusions: In the US VVF remains a rare entity. Over half of VVFs were repaired vaginally. The occurrence of serious complications is low. A vaginal approach appears to be associated with fewer complications.

Original languageEnglish (US)
Pages (from-to)1622-1628
Number of pages7
JournalNeurourology and Urodynamics
Volume36
Issue number6
DOIs
StatePublished - Aug 2017
Externally publishedYes

Keywords

  • demographics
  • developed countries
  • risk factors
  • trends
  • vesicovaginal fistula

ASJC Scopus subject areas

  • Clinical Neurology
  • Urology

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