Methods:
An IRB approved retrospective cohort study was performed to identify the
incidence of and risk factors for perioperative blood transfusions after
surgical repair of urogenital fistula in Uganda. The study was conducted
among women who underwent fistula repair between 2013-2019 at the Kitovu
Hospital in Masaka, Uganda. Kitovu Hospital is one of three private,
faith-based hospitals under the partnership of the USAID Fistula Care
Plus. Complex fistula cases from many geographical areas are often
referred to the hospital which has a specialized fistula repair unit.
All types of urogenital fistula were included (vesicovaginal,
urethrovaginal, vesicouterine, and those with ureteral involvement).
Those who had concomitant rectovaginal fistulas were included so long as
they underwent repair of the urogenital fistula. A surgical database,
established in 2013 from patient charts, was used to identify those who
underwent urogenital fistula repair during that time period and
determine eligibility for inclusion. After identification of included
patients within our cohort, a retrospective chart review was performed
to gather all remaining variables of interest including patient
demographics, medical and surgical history, as well as perioperative
details. Primary outcome was the need for perioperative blood
transfusion. Patient characteristics were then compared between those
who did and did not require perioperative blood transfusion after
urogenital fistula repair.
Descriptive statistics were calculated for a number of demographic and
clinical characteristics to describe the full sample and women with and
without a transfusion. Results were reported as mean with standard
deviation (or median with interquartile range) for continuous variables
and frequency with percentages for categorical variables. Logistic
regression was used to estimate unadjusted odds ratios (ORs) and 95%
confidence intervals (CIs) representing the association between each
risk factor of interest and blood transfusion. Risk factors were chosen
a priori based on previous literature and clinical knowledge and
included patient age, time with fistula, type of delivery, delivery
outcome, cause of fistula, history of fistula repair, HIV status,
presence of foot drop, surgical approach, anesthesia type, concomitant
surgery, use of a graft or flap as part of their surgery, a concomitant
sling procedure, complications, use of ureteric catheter, and surgeon
training. A multivariable logistic regression model was used to estimate
adjusted ORs and 95% CIs; only covariates that were significantly
associated with risk of blood transfusion in univariate analyses were
included in the adjusted model. Categorical subgroups were created for
covariates with missing data and included in the models. All statistical
tests were two-sided and declared significant at p < 0.05.
Statistical analyses were performed with SAS software, version 9.4 (SAS
Institute, Inc., Cary, NC).