Complications After Vesicovaginal Fistula Repair Based on Surgeon Specialty in the United States: Analysis of a National Database

Abstract

ObjectivesThis study aimed to compare the rates of major and minor complications for vesicovaginal fistula (VVF) repair based on surgeon specialty and to identify risk factors for adverse outcomes.MethodsThis was a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program between the years 2014 and 2019. Cases were identified using Current Procedural Terminology codes for VVF repair. Minor and major complication rates for VVF repair were compared between 2 cohorts defined by surgeon specialty: gynecology versus urology. Additional outcomes included readmissions and reoperations. Multivariable logistic regression analysis was performed to investigate risk factors for complications.ResultsA total of 319 VVF repairs were included in the analysis, of which 115 (36.1%) were performed by gynecologists and 204 (63.9%) by urologists. There were no significant differences in the demographic or medical characteristics between the gynecology and urology cohorts except for race. Gynecologists performed more concomitant hysterectomies (10.4% vs 1.0%, P < 0.001) and apical suspension procedures (6.1% vs 0%, P < 0.001). There were no differences in minor (7.8% vs 6.4%, P = 0.623) or major (2.6% vs 3.4%, P = 1.000) complications between the cohorts. The overall readmission rate was 4.7%, and the reoperation rate was 2.2% with no differences between specialties. On multivariable logistic regression analysis, body mass index and concurrent hysterectomy were risk factors for major or minor complications with no increased risk associated with surgeon specialty or route of surgery.ConclusionsComplication rates did not differ for VVF repairs performed by gynecologists compared with urologists. Readmission and reoperation rates were low for both groups.

Reparación quirúrgica por vía vaginal de fístulas vesicovaginales: una experiencia exitosa

“…No hubo diferencias en las complicaciones menores (7,8% frente a 6,4%) ni mayores (2,6% frente a 3,4%) entre las cohortes. La tasa global de reingresos fue del 4,7% y la tasa de reoperaciones fue del 2,2%, sin diferencias entre especialidades 10 . En nuestro caso, todas las reparaciones descritas fueron realizadas por ginecólogos y urólogos especialistas en piso pélvico, quienes realizaron programas formales de fellowship de por lo menos 2 años de duración, con resultados similares a los descritos por Romanova et al 10 en su estudio.…”