56: Evaluating risk factors associated with need for blood transfusions after urogenital fistula repair in Uganda

Abstract

Urogenital fistulae are a devastating condition prevalent in countries where women do not readily have access to emergency obstetric services. In this study, our primary objective was to determine the incidence of and risk factors for perioperative blood transfusions after urogenital fistulae repair in Uganda. An IRB approved retrospective cohort study was conducted to identify the incidence of and risk factors for blood transfusions after urogenital fistula repair. Inclusion criteria included women who underwent repair of urogenital fistula at Kitovu Hospital in Masaka, Uganda between 2013 and 2018. All types of urogenital fistula were included (vesicovaginal, urethrovaginal, vesicouterine, and those with ureteral involvement). Descriptive statistics were calculated for demographic and clinical covariates. Logistic regression was used to calculate the crude odds ratios (ORs) and 95% confidence intervals (CIs) for each risk factor of interest. A final model was constructed using stepwise multivariable logistic regression in which risk factors with a significance level <0.05 remained in the model. All statistical tests were two-sided and declared significant at p < 0.05. A total of 546 patients treated for urogenital fistulae were identified. The median age was 31.3 ± 13.2. Median duration of labor was 48 hours (interquartile range: 36-72 hours). Median parity was 3 (interquartile range: 1-6). Approximately 94% of fistulae were caused by obstetric means, while 4% were related to gynecologic surgery. Less than a third of patients had previous fistula repairs (25.5%). Most VVF patients delivered via Cesarean section (58.6%), and 23.8% delivered via spontaneous vaginal delivery. The most common location of fistulae were juxta-cervical or vault fistulas (20.7%). A vaginal surgical approach was used in the majority of patients (84.6%) compared to abdominal (11.7%) or combined approaches (3.5%). Complications occurred in 3.5% of surgical repairs, and the incidence of blood transfusions was 6.2%. Multivariable analyses identified time with fistula, surgical approach, and delivery outcomes as statistically significant risk factors of a need for blood transfusions. Patients who delivered stillbirths were 3.84 (95% CI: 1.23–11.97) times more likely to require postoperative blood transfusions than live births, while surgical fistula repairs approached abdominally (non-vaginally) were 8.10 (95% CI: 3.53–18.60) times more likely to require transfusions than vaginal operations. Furthermore, patients who had been living with the condition for less than three months had a higher risk of a blood transfusion. This study identified an incidence of blood transfusions among urogenital fistula repairs in our population of approximately 6%. Time with fistula, delivery outcomes and surgical approach were significant risk factors for the need for blood transfusions.