Results:
A total of 546 patients who underwent fistula repairs from 2013-2019 met
inclusion criteria and were included in the study. Patient
characteristics are outlined in Table 1. The mean 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). The median time
suffering from the condition before repair was 6 months (interquartile
range: 0.25-5 years). Preoperative characteristics are described in
Table 2. Most fistula patients delivered via Cesarean section (58.6%)
and 23.8% delivered via spontaneous vaginal delivery. A majority of
fistula patients delivered still births (65.4) versus livebirths
(17.6%). A quarter of patients had undergone previous repair of their
fistula (25.5%). The most common location of fistulas was
juxta-cervical or vault fistulas (20.7%). A vaginal surgical approach
was used in the majority of patients (84.6%) compared to an abdominal
approach (11.7%). Post-operative complications occurred in 3.5% of
patients. The incidence rate of blood transfusions was 6.2%.
Risk factors examined are included in Table 3. The risk factors that
were associated with blood transfusions in univariate analyses were time
with fistula, surgical approach, anesthesia type, and whether the
patient had any complications. Multivariable analyses identified
abdominal surgical approach as the only statistically significant risk
factor of a need for blood transfusions. Surgical fistula repairs
approached abdominally (non-vaginally) were four times more likely (aOR:
4.30, 95% CI: 1.85–10.00) to require transfusions than vaginal
operations. An inverse borderline association was observed between
timing of repair and perioperative transfusions, such that patients who
underwent repair after three months from the time of developing the
fistula were at lower risk of perioperative transfusions (aOR: 0.48,
95% CI: 0.22–1.04).