title: Vesicovaginal fistulas in the developed world: An analysis of disease characteristics, treatments, and complications of surgical repair using the ACS-NSQIP database.
abstract: OBJECTIVE
  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.
authors: Department of Urology, Columbia University Medical Center, New York, New York.
authors: Marissa C
authors: MC
authors: Theofanides
authors: Department of Urology, Columbia University Medical Center, New York, New York.
authors: Wilson
authors: W
authors: Sui
authors: Department of Urology, Columbia University Medical Center, New York, New York.
authors: Elisabeth M
authors: EM
authors: Sebesta
authors: Department of Urology, Columbia University Medical Center, New York, New York.
authors: Ifeanyi
authors: I
authors: Onyeji
authors: Department of Urology, Columbia University Medical Center, New York, New York.
authors: Justin T
authors: JT
authors: Matulay
authors: Department of Urology, Columbia University Medical Center, New York, New York.
authors: Doreen E
authors: DE
authors: Chung
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000209:etiology; D014719:Vesicovaginal Fistula / Q000150:complications / Q000601:surgery*
keywords: demographics; developed countries; risk factors; trends; vesicovaginal fistula