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).