title: Lower reproductive tract fistula repairs in inpatient US women, 1979-2006.
abstract: OBJECTIVE
  The objective of the study was to characterize trends in lower reproductive tract fistula (LRTF) repair in inpatient US women from 1979 to 2006.
  
  
  METHODS
  Retrospective data was obtained from the National Hospital Discharge Survey regarding LRTF diagnoses, demographics, comorbidities, and fistula repair procedures, using ICD-9-CM diagnostic and procedure codes. Age-adjusted rates (AARs) were calculated using 1990 census data. Trends in LRTF surgical repair were evaluated using regression analysis.
  
  
  RESULTS
  Between 1979 and 2006, the AAR of LRTF repair declined from 7.8 to 4.8 per 100,000 women (b = -2.97, p < 0.001). The most common surgical fistula repairs were rectovaginal, vesicovaginal, and colovaginal. The AARs of colovaginal and vesicovaginal fistula repair remained stable, while the AAR of rectovaginal fistula repair declined.
  
  
  CONCLUSIONS
  The AAR of inpatient LRTF repair declined between 1979 and 2006, perhaps reflecting a concurrent decrease in obstetric trauma, in the context of decreasing episiotomy and operative vaginal delivery and increasing cesarean section rates.
authors.affiliation: Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. heidi.brown@gmail.com
authors.forename: Heidi W
authors.initials: HW
authors.lastname: Brown
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Clareann H
authors.initials: CH
authors.lastname: Bunker
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Lowder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002585:Cesarean Section / Q000639:trends; D036861:Delivery, Obstetric / Q000009:adverse effects; D004841:Episiotomy / Q000639:trends; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007412:Intestinal Fistula / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D012006:Rectovaginal Fistula / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014719:Vesicovaginal Fistula / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D055815:Young Adult