17: Perioperative adverse events by route of surgery in patients undergoing rectovaginal fistula repair in the United States

Abstract

The objective of this study is to compare the incidence of adverse events associated with rectovaginal fistula (RVF) repair between routes of surgery. This was a retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2013 to 2016. All cases were identified by the CPT codes used for closure of a rectovaginal fistula by the “vaginal or transanal approach” (57300) or “abdominal approach” (57305). We excluded patients whose RVF was associated with malignancy, post-surgical complications, infection, or ischemia. Once patients were identified, patient characteristics, operative data, and 30-day post-operative events were collected. The primary outcome was the composite complication rate as defined by NSQIP. Overall, 752 female patients met inclusion criteria. Of these, 483 (64.2%) had an RVF repair with a vaginal/transanal approach and 269 (36.3%) underwent an abdominal approach. The composite complication rate for all groups was 13% (98) with complication rates differing significantly by route of surgery: 7.5% vaginal/transanal vs 23% abdominal, p<0.001. Patients who underwent an abdominal approach were more likely to have had a longer operation time, longer length of hospital stay, and a higher incidence of readmission (Table 1). When age, race, pre-operative hematocrit, and ASA class were controlled for, the abdominal approach remained significantly associated with a higher post-operative complication rate: adjOR 2.88 (95% CI 1.79-4.73). In this large national database, 13% of patients undergoing RVF repair had a post-operative complication within 30 days of surgery. Patients who had an abdominal approach for RVF repair had a nearly 3-fold risk of developing a post-operative complication compared to those patients who had a vaginal/transanal approach.