(Poster 41) Evaluating the Effect of Fecal Diversion on Rectovaginal Fistula Repair Outcomes

Objectives: Utilize NSQIP surgical database to compare preoperative and 30-day postoperative outcomes for patients who underwent simple rectovaginal fistula (RVF) repairs with patients who underwent complex RVF repairs with concurrent fecal diversion procedure.

Methods: The National Surgical Quality Improvement Program (NSQIP) database collects yearly preoperative, intraoperative, and 30-day postoperative outcomes from patients across the United States in over 700 hospitals. In our retrospective study, all patients who underwent RVF repair between 2011-2022 were collected. Two groups of female adults were created using CPT codes; those who exclusively underwent RVF repair, and those who also had a concurrent fecal diversion procedure. Patients with cancer as a preoperative variable were excluded. Preoperative characteristics, intraoperative characteristics, and postoperative outcomes were compared between groups. Descriptive statistics were used for comparisons as appropriate. Multivariate logistic regression analyses were performed to identify variables independently associated with ‘any’, ‘major’, and ‘minor’ postoperative complications by surgical group type. Propensity scoring was used to account for baseline differences in preoperative patient characteristics.

Results: A total of 1,608 patients were initially collected. 1,258 patients comprised the simple RVF repair group, while 312 comprised the complex repair group. Baseline characteristics showed statistically significant differences existed for all characteristics except race and tobacco use, Table 1. The number of outpatient procedures was significantly greater for patients who underwent simple repair, while the length of operation and total blood loss was significantly higher in the complex repair group (p < 0.001). With regard to postoperative outcomes, significantly more major and minor complications occurred in the complex repair group (34.4% vs 15.2%, p< 0.001). Readmission rates were also significantly higher in this group (6.1% vs 5.4%, p< 0.001). The regression analysis found smoking and ASA status were independently predictive of any complication. The odds ratio for any complication in the complex repair procedure group was 2.94 [2.17, 3.98]. A propensity scoring was then used to generate matched cohorts by baseline characteristics and trends continued.

Conclusions: Complex RVF repairs were associated with a greater number of minor and major postoperative complications. Patients with preoperative comorbidities were more likely to undergo a diversion procedure. This study may be used to aid in informed decision making with patients when deciding repair method by providing assessment of complication rates in a large national cohort. While the risk of complication is greater with diversion procedure, this approach may result in greater likelihood of fistula repair success, which is not captured in this data. Future studies are needed to look at long-term outcomes, particularly RVF recurrence rates, between the groups in this study.