(Poster 123) Social Impacts on Surgical Outcomes of Rectovaginal Fistula Repairs

Objectives: To assess usual factors and social drivers of health (SDoH) associated with success or failure of rectovaginal fistula (RVF) surgical repair performed by a multidisciplinary team.

Methods: We performed a retrospective review of patients who underwent RVF repair performed by a multidisciplinary team (urogynecologist and colorectal surgeon) between 11/2019 and 12/2024. Demographics, usual factors, and SDoH domains were extracted from patient charts. A successful closure was defined as a visually healed RVF with absence of vaginal flatus or stool drainage by 6 months postoperatively or earlier. Wilcoxon sum rank test and Fisher’s exact tests were used to compare surgical outcomes by sociodemographic factors.

Results: Of the 18 patients included, 11 (61.1%) achieved successful RVF closure by 6 months. Overall, patients with successful repair were younger (median age 35 vs. 59 years; p=0.0413), lived closer to an obstetrics and gynecology provider (3.6 vs. 8.2 miles; p=0.0414), and were more likely to have commercial insurance (72.7% vs. 42.9%; p=0.0460) compared to those without successful closure. Additionally, 55.6% (n=10) of patients underwent RVF repair previously. For those with history of previous repairs, 50% (n=5) had successful closure at 6 months, 50% (n=5) had inflammatory bowel disease, and 30% (n=3) were diabetic. A total of 9 patients (50%) had at least one SDoH domain documented. Of those patients, 7 (38.9%) had at least one SDoH recorded as high/medium risk for experiencing negative health outcomes. Among patients with a failed closure, 42.9% had at least one SDoH documented as high risk compared to 9.1% of patients with a successful closure. The most common high-risk SDoH domains recorded among the patients with a failed closured included stress (42.9%), physical activity (28.6%), transportation needs (26.6%). Among patients with a successful repair, only one patient had high-risk recorded. This patient was high risk for financial strain, food insecurity, and physical activity.

Conclusions: RVF surgical repair can be challenging, and closure success rates significantly decline with each subsequent repair. Consequently, it is imperative to better understand modifiable risk factors that may affect successful repair healing. To our knowledge, this study is the first to specifically evaluate impact of SDoH on RVF repair, finding that those with successful repairs were more likely to be lower risk in the reported SDoH categories, live closer to their primary obstetrician/gynecologist, and have commercial insurance. Therefore, collection of SDoH data and addressing noted inadequacies for patients undergoing RVF repair may be another way to improve surgical outcomes for this population.