Rectourethral fistulas: A comparison of the National Inpatient Sample and the American College of Surgeons National Surgical Quality Improvement Program.
BACKGROUND
The National Surgical Quality Improvement Program (NSQIP) and the National Inpatient Sample (NIS) may be used to evaluate outcomes for uncommon conditions such as rectourethral fistulas (RUFs). We sought to review cases of RUFs and compare variables from both registries to evaluate disparities among reported data.


METHODS
Review of NSQIP (2005-2013) and NIS (2006-2011) of all patients with a RUF or RUF repair based on ICD-9-CM or CPT coding.


RESULTS
The NSQIP and NIS data sets were compared based on International Classification of Diseases, 9th Revision, Clinical Modification diagnosis coding for a RUF (599.1; American College of Surgeons National Surgical Quality Improvement Program: n = 286, NIS: n = 2,357). Comorbidities varied between data sets, and in-hospital morbidity in RUF cases was greater in the NIS vs NSQIP data sets (48% vs 11%; P < .01). Further analysis identified similar outcomes when cases of a RUF that underwent an operation were compared in the NSQIP (n = 284) and NIS (n = 274) database.


CONCLUSIONS
This study represents the largest cohort of RUF cases and characterizes how using variables from both databases better elucidates details of this rare condition. These results exhibit how evaluating comparable metrics demonstrates inconsistencies between databases.
Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
Andrew T
AT
Schlussel
Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI, USA.
Michael B
MB
Lustik
Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Conor P
CP
Delaney
Division of Colorectal Surgery, University Hospitals-Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue LKS 5047, Cleveland, OH 44106, USA.
Sharon L
SL
Stein
Division of Colorectal Surgery, University Hospitals-Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue LKS 5047, Cleveland, OH 44106, USA.
Harry L
HL
Reynolds
Department of Colon and Rectal Surgery, University of Texas Medical Branch Hospitals, Galveston, TX, USA; University of Texas Medical Branch, Galveston, TX, USA.
Anthony J
AJ
Senagore
MultiCare Cedars Surgical Associates, Tacoma, WA, USA.
Eric K
EK
Johnson
Division of Colorectal Surgery, University Hospitals-Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue LKS 5047, Cleveland, OH 44106, USA. Electronic address: harkersteele@mac.com.
Scott R
SR
Steele
D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000453:epidemiology; D012003:Rectal Fistula / Q000453:epidemiology / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014522:Urethral Diseases / Q000453:epidemiology / Q000601:surgery*; D014548:Urinary Fistula / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
Fistula; Outcomes assessment; Rectum; Urethra