Abstract
Introduction and hypothesis
There are limited data comparing patient and operative characteristics for vaginal repair of vesicovaginal fistula (VVF) by surgeon specialty. Our objective was to compare national practice patterns by surgeon specialty for vaginal repair of VVF.
Methods
Using the American College of Surgeons National Surgical Quality Improvement Program database, we conducted a retrospective cohort analysis of women who underwent vaginal repair of VVF from 2010 to 2019. Demographic and perioperative characteristics were compared by surgeon specialty.
Results
A total of 252 women were analyzed. Urologists performed 57% of cases (n=144), gynecologists performed 38% (n=96), and general surgeons performed 5% (n=12). There were differences among surgeon specialties in patient characteristics including age (p=0.002), creatinine (p=0.002), hypertension (p=0.02), morbidity probability (p<0.001), hospital stay (p<0.001), inpatient status (p=0.03). Urologists were more likely than gynecologists to use grafts/flaps (p=0.002). There were trending differences among surgeon specialties in patient race (p=0.07) and ethnicity (p=0.06). Urologists and gynecologists were more likely to operate on younger, healthier patients with differences in racial populations. When directly comparing urologists with gynecologists, there were differences in race (p=0.05) and a trending difference in ethnicity (p=0.06), General surgeons were more likely to operate on older white women with worse health status, more concomitant procedures, and longer hospital stay.
Conclusions
Urologists, gynecologists, and general surgeons perform vaginal repair of VVF. Among these specialties, there were differences in patient and perioperative characteristics. This information may help referring providers and patients to understand which types of surgical providers most commonly manage VVF.
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Acknowledgements
We would like to thank the hospitals affiliated with the University of North Carolina. We would like to thank Christopher Wiesen of The Odum Institute at UNC Chapel Hill for consultation on statistics and Jamie Conklin of the UNC Health Sciences Library for consultation on the literature review.
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Geller and Margulies significantly contributed to the project development, data collection, data analysis, manuscript writing and editing.
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No relevant financial disclosures or conflicts of interest. Dr. Geller is an unpaid speaker and has received a grant from Boston Scientific as well as provides freelance expert testimony.
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Margulies, S.L., Geller, E.J. Vaginal repair of vesicovaginal fistula: comparison of national practice patterns by surgeon specialty. Int Urogynecol J 33, 1675–1683 (2022). https://doi.org/10.1007/s00192-022-05199-1
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DOI: https://doi.org/10.1007/s00192-022-05199-1