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abstract

55 - NATIONAL COMPLICATION RATE OF VESICOVAGINAL FISTULAS IN THE US

055

NATIONAL COMPLICATION RATE OFVESICOVAGINAL FISTULAS IN THE US

D. H. AKINGBA1, C.POWELL 2, J. DAI 3;
1Urogynecology,Wayne State, Detroit, MI, 2Urology, IUPUI, Indianapolis,IN, 3Statitistics, Wayne State, Detroit, MI.

Introduction: VesicovaginalFistula (VVF) is a rare, debilitating complication of inadvertentcystotomy. The national complication rate of VVF after inadvertentcystotomy has not been reported in the United States.
Objective:First, we aimed to determine the risk factors for VVF and inadvertentcystotomy. Second, we aimed to determine the national rate ofinadvertent cystotomy and VVF formation.
Methods: We used 2national databases. 2011 - 2013 HCUPS National Inpatient Sample (NIS)was queried for cystotomies, VVF’s, co-morbidities and riskfactors. The 2013 HCUPS National Readmission Database (NRD) wasqueried for inadvertent cystotomies after pelvic surgery and then forreadmissions of the same patients with VVF.
Results: Bothcystotomy and VVF occurred rarely. The national incidence cystotomyrepair was 0.51% following all pelvic surgeries combined (Table 2).The national incidence of VVF repair following all pelvic surgerieswas 0.046%. The national incidence of VVF repair after cystotomyrepair was 8.9%. The surgery with the highest rate of cystotomyrepair was urethral sphincterotomy (37% of 65 annual cases). Theprocedure with the highest incidence of VVF repair was repair of thebladder neck (2.53% of 2770 annual cases). Owing to the large numberof inpatient hysterectomies performed annually in the US, the rate ofcystotomy and VVF repair was low (2% and 0.13% of 265,000 cases,respectively). However, hysterectomies accounted for 15% of allcystotomy and 40% of all VVF repairs (5312 out of 1.7 mil cystotomiesand 315 out of 880 VVF’s formed 2013), making it the most commonsurgery preceding cystotomy and VVF. 75% of all VVF's were repairedat urban non-teaching hospitals. Obesity, hypertension, diabetes,pelvic organ prolapse, urinary incontinence, kidney disease, anduterine fibroids increased the risk of cystotomy (Table 1). Kidneydisease, pelvic organ prolapse, urinary incontinence, rheumatoidarthritis, hypertension and female genital cancer increased the riskof VVF. African Americans had a disproportionately higher rate ofinadvertent cystotomy and VVF (p-value 0.0 1).
Conclusions:The national rate of VVF after cystotomy is low 8.9%. As 92 percentof all VVF’s reported in the database followed the pelvic surgeriesstudied, we conclude that the greatest risk factor for VVF in theUnited States is inadvertent cystotomy during the seven pelvicsurgeries listed in this study. Having certain medical co-morbiditieslike metabolic syndrome, diseases that may distort the anatomy suchas obesity, female genital cancer and prolapse, puts women at ahigher risk for cystotomy and VVF.
References: 1. MellanoEM, Tarney CM. Management of Genitourinary Fistula. Current Opinion2014; 26: 415 - 423. 2. Frankman E, Wang L, Bunker C, Lowder J. LowerUrinary tract Injury in Women in the United States, 1979 - 2006.2010. AJOG, 495: e1 -5. 3. Trovik J, Thornhill H, and Kiserud T.Incidence of Obstetric Fistula in Norway: a Population-basedProspective Cohort Study. Acta. Obstetricia et GynecologicaScandinavica. 2016 : 1-6. 4. Cromwell D and Hilton P. RetrospectiveCohort Study on Patterns of Care and Outcomes of Surgical Treatmentfor Lower Urinary-Genital Tract Fistula Among English National HealthService Hospitals Between 200 and 2009. 2012; BJUI. 111: E257-62.

Table2.1






PelvicSurgery

PrimaryAdmission

CystotomyReadmission

InjuryRate

Proportionof Injuries

Hysterectomies

265835

5312.75

2.00

14.11

Prolapsesurgery

65645

409.79

0.62

1.09

Roboticprocedure

155365

134.75

0.09

0.36

Cesarean

1228846

2505.67

0.20

6.66

TUBT

32385

591.35

1.83

1.57

Sphincterotomy

65

24.61

37.86

0.07

Bladderneck repair

2770

154.23

5.57

0.41

Cystotomy

37650




Total

1788561

9133

0.51

24.26


Table2.2

PelvicSurgery

PrimaryAdmission

VVFReadmission

InjuryRate

Proportion

Hysterectomies

265835

357.34

0.134

40.61

ProlapseSurgery

65645

87.50

0.133

9.94

Roboticprocedure

155365

188.07

0.121

21.37

Ceserean

1228846

37.74

0.001

4.29

TUBT

32385

74.26

0.229

8.44

Sphincterotomyof Bladder

65

0

0

0

Bladderneck repair

2770

70.09

2.530

7.96

VVF

880




Total


815

0.046

92.61


Table1

RiskFactor

Cystotomyp value

CystotomyOR

VVFp value

VVFOR

Obesity

<0.01

1.45CI (1.3 - 1.5

<0.01

0.90CI (0.85- 0.96)

Diabetes

<0.01

1.43CI (1.3 - 1.5)

0.4

0.98CI (0.9 - 1.3)

KidneyDisease

<0.01

2.0CI (1.8 - 2.2)

<0.01

1.2CI (1.2 - 1.3)

Depression

0.15

1.0CI (0.97 - 1.2)

<0.01

1.3CI (1.2 - 1.4)

PelvicOrgan Prolapse

<0.01

3.4CI (2.7 - 4.2)

<0.01

3.0CI (2.6 - 3.5)

UrinaryIncontinence

<0.01

4.8CI 4.4 - 5.3)

<0.01

3.4CI (3.2 - 3.7)

Fibroids

0.01

3.3CI (2.8 - 4.0)

0.01

0.75CI (0.6 - 0.9)

Lupus

0.64

0.9CI (0.6- 1.3)

0.89

0.98CI (0.79 - 1.2)

RheumatoidArthritis

0.34

0.9CI (0.7 - 1.1)

0.02

1.2CI (1.1 - 1.3)

Hypertension

<0.01

1.2CI (1.1 - 1.3)

<0.01

1.2CI (1.1 - 1.3)

FemaleGenital Cancer

0.87

1.0(0.7 - 1.5)

<0.01

6.5CI (5.9 - 7.2)