title: Risk factors associated with postoperative morbidity in over 500 colovesical fistula patients undergoing colorectal surgery: a retrospective cohort study from ACS-NSQIP database.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of various factors on 30-day postoperative morbidity in patients who underwent colorectal surgery (CRS) for colovesical fistula (CVF) in the elective and emergency settings.
  
  
  METHODS
  Patients who underwent CRS for CVF between 2005 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database by using current procedural terminology codes. Demographics, perioperative, and operative factors were assessed and compared between two groups classified according to the presence or absence of postoperative complications.
  
  
  RESULTS
  Five hundred twelve patients met the inclusion criteria [mean age of 61.4 (±14.7) years, female 214 (42%)]. Etiology of fistula was diverticulitis [N = 438 (85.5%)], colon cancer [N = 39 (7.6%)], and Crohn's disease [N = 35 (6.8%)]. One hundred fifty-two procedures (29.7%) were performed laparoscopically. In 186 patients (36%), no bladder intervention was performed. One hundred forty-nine patients (29.1%) had at least one postoperative complication. Patients who developed complication were older (P = <0.001), more often female (P = <0.001), hypertensive (P = 0.005), anemic (P = <0.001), preoperatively transfused (P = 0.02), and with class 2-3 wound classification (P = 0.01). Independent risk factors affecting morbidity were increased age [odds ratio (OR) 1.23 (1.03-1.47), P = 0.01], decreased hematocrit level [OR 3.04(1.83-5.06), P < 0.0001], and open approach [OR 2.56 (1.35-4.84), P = 0.003].
  
  
  CONCLUSIONS
  Morbidity for CVF remains high. Lower preoperative hematocrit level and increased age were associated with higher risk of complication. Laparoscopic surgery may be preferable when possible as morbidity is less with this approach.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
authors.forename: H Hande
authors.initials: HH
authors.lastname: Aydinli
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
authors.forename: Cigdem
authors.initials: C
authors.lastname: Benlice
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA. ozunerg@ccf.org.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ozuner
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
authors.forename: Emre
authors.initials: E
authors.lastname: Gorgun
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
authors.forename: Maher A
authors.initials: MA
authors.lastname: Abbas
mesh_terms: D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects*; D019992:Databases as Topic; D003710:Demography; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: ACS-NSQIP data; Colovesical fistula; Morbidity; Risk factors