TY - JOUR
T1 - Vesicovaginal fistulas in the developed world
T2 - An analysis of disease characteristics, treatments, and complications of surgical repair using the ACS-NSQIP database
AU - Theofanides, Marissa C.
AU - Sui, Wilson
AU - Sebesta, Elisabeth M.
AU - Onyeji, Ifeanyi
AU - Matulay, Justin T.
AU - Chung, Doreen E.
N1 - Publisher Copyright:
© 2016 Wiley Periodicals, Inc.
PY - 2017/8
Y1 - 2017/8
N2 - 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.
AB - 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.
KW - demographics
KW - developed countries
KW - risk factors
KW - trends
KW - vesicovaginal fistula
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U2 - 10.1002/nau.23167
DO - 10.1002/nau.23167
M3 - Article
C2 - 27794173
AN - SCOPUS:85025085531
SN - 0733-2467
VL - 36
SP - 1622
EP - 1628
JO - Neurourology and Urodynamics
JF - Neurourology and Urodynamics
IS - 6
ER -