Mortality risk associated with surgical treatment of female genital fistula.
OBJECTIVE
To describe the mortality risk associated with surgical treatment of female genital fistula and the contributory and contextual factors.


METHODS
In a descriptive study, confidential inquiries and clinical audits were conducted at 14 fistula repair sites in seven resource-poor countries between January 2005 and March 2013. Data collection included interviews with key personnel involved in the clinical management of the deceased, and a review of hospital records and patient files following an audit protocol.


RESULTS
Overall, 26060 fistula repairs were performed at 44 sites located in 13 countries; 30 deaths were reported in this period. Twenty-one deaths were attributable to surgery, yielding a case fatality of 0.08 per 100 procedures. The cause of death in nearly half of the cases was various manifestations of sepsis and inflammation.


CONCLUSIONS
The case fatality rate for fistula repair surgery in resource-poor countries was in the same range as that for comparable gynecologic operations in high-resource settings. Clinical and systemic issues to be addressed to reduce the case fatality rate include improvement of perioperative care and follow-up, assuring prudent referral or deferral of difficult cases, and maintaining better records.
Fistula Care, EngenderHealth, NY, USA. Electronic address: jruminjo@engenderhealth.org.
Joseph
J
Ruminjo
Fistula Care, EngenderHealth, NY, USA.
Evelyn
E
Landry
Fistula Care, EngenderHealth, NY, USA.
Karen
K
Beattie
Fistula Care, EngenderHealth, Sokoto, Nigeria.
Adamu
A
Isah
Fistula Care, EngenderHealth, Dhaka, Bangladesh.
Abu Jamil
AJ
Faisel
Fistula Care, EngenderHealth, Conakry, Guinea.
Sita
S
Millimono
D003906:Developing Countries; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000401:mortality*; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality*; D012306:Risk; D014624:Vaginal Fistula / Q000601:surgery*
Confidential inquiry; Female genital fistula; Mortality risk; Surgical treatment