Skip to main content

Advertisement

SpringerLink
Log in

Risk factors associated with postoperative morbidity in over 500 colovesical fistula patients undergoing colorectal surgery: a retrospective cohort study from ACS-NSQIP database

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to evaluate the impact of various factors on 30-day postoperative morbidity in patients who underwent colorectal surgery (CRS) for colovesical fistula (CVF) in the elective and emergency settings.

Methods

Patients who underwent CRS for CVF between 2005 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database by using current procedural terminology codes. Demographics, perioperative, and operative factors were assessed and compared between two groups classified according to the presence or absence of postoperative complications.

Results

Five hundred twelve patients met the inclusion criteria [mean age of 61.4 (±14.7) years, female 214 (42%)]. Etiology of fistula was diverticulitis [N = 438 (85.5%)], colon cancer [N = 39 (7.6%)], and Crohn’s disease [N = 35 (6.8%)]. One hundred fifty-two procedures (29.7%) were performed laparoscopically. In 186 patients (36%), no bladder intervention was performed. One hundred forty-nine patients (29.1%) had at least one postoperative complication. Patients who developed complication were older (P = <0.001), more often female (P = <0.001), hypertensive (P = 0.005), anemic (P = <0.001), preoperatively transfused (P = 0.02), and with class 2–3 wound classification (P = 0.01). Independent risk factors affecting morbidity were increased age [odds ratio (OR) 1.23 (1.03–1.47), P = 0.01], decreased hematocrit level [OR 3.04(1.83–5.06), P < 0.0001], and open approach [OR 2.56 (1.35–4.84), P = 0.003].

Conclusions

Morbidity for CVF remains high. Lower preoperative hematocrit level and increased age were associated with higher risk of complication. Laparoscopic surgery may be preferable when possible as morbidity is less with this approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dao HE, Miller PE, Bhattacharya S, Klipfel A, Vrees M, Schechter S (2014) Laparoscopic colectomy is an underused procedure for the elective management of colovesical fistulas. Am Surg 80:412

    PubMed  Google Scholar 

  2. Kellogg WA (1938) Vesico-intestinal fistula. Am J Surg 41:135–186

    Article  Google Scholar 

  3. Scozzari G, Arezzo A, Morino M (2014) Enterovesical fistulas: diagnosis and management. Techniques in coloproctology 14:293–300

    Article  Google Scholar 

  4. Daniels I, Bekdash B, Scott H, Marks C, Donaldson D (2014) Diagnostic lessons learnt from a series of enterovesical fistulae. Color Dis 4:459–462

    Article  Google Scholar 

  5. Holroyd D, Banerjee S, Beavan M, Prentice R, Vijay V, Warren S (2012) Colovaginal and colovesical fistulae: the diagnostic paradigm. Techniques in coloproctology 16:119–126

    Article  CAS  PubMed  Google Scholar 

  6. Kirsh GM, Hampel N, Shuck JM, Resnick MI (1991) Diagnosis and management of vesicoenteric fistulas. Surg Gynecol Obstet 173:91–97

    CAS  PubMed  Google Scholar 

  7. Lidsky ME, Thacker JKM, Lagoo-Deenadayalan SA, Scarborough JE (2012) Advanced age is an independent predictor for increased morbidity and mortality after emergent surgery for diverticulitis. Surgery 152:465–472

    Article  PubMed  Google Scholar 

  8. Leichtle SW, Mouawad NJ, Lampman R, Singal B, Cleary RK (2011) Does preoperative anemia adversely affect colon and rectal surgery outcomes? J Am Coll Surg 212:187–194

    Article  PubMed  Google Scholar 

  9. Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A et al (2011) Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 378:1396–1407

    Article  PubMed  Google Scholar 

  10. Kiani QH, George ML, Carapeti EA, Schizas AM, Williams AB (2015) Colovesical fistula: should it be considered a single disease? Annals of coloproctology 31:57–62

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pokala N, Delaney C, Brady K, Senagore A (2005) Elective laparoscopic surgery for benign internal enteric fistulas: a review of 43 cases. Surgical Endoscopy And Other Interventional Techniques 19:222–225

    Article  CAS  PubMed  Google Scholar 

  12. Abbass MA, Tsay AT, Abbas MA (2013) Laparoscopic resection of chronic sigmoid diverticulitis with fistula. JSLS: Journal of the Society of Laparoendoscopic Surgeons 17:636

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tam M, Abbass M, Tsay A, Abbas M (2014) Outcome of colonic fistula surgery in the modern surgical era. Techniques in coloproctology 18:467–472

    Article  CAS  PubMed  Google Scholar 

  14. Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley FL (1988) Internal fistulas in diverticular disease. Dis Colon Rectum 31:591–596

    Article  CAS  PubMed  Google Scholar 

  15. Engledow A, Pakzad F, Ward N, Arulampalam T, Motson R (2007) Laparoscopic resection of diverticular fistulae: a 10-year experience. Color Dis 9:632–634

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA

    H. Hande Aydinli, Cigdem Benlice, Gokhan Ozuner, Emre Gorgun & Maher A. Abbas

Authors
  1. H. Hande Aydinli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cigdem Benlice
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gokhan Ozuner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emre Gorgun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maher A. Abbas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gokhan Ozuner.

Ethics declarations

Disclaimer

American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Conflict of interest and source of funding

The authors declare that they have no conflict of interest.

Additional information

State: The study was presented as poster at the American Society of Colon and Rectal Surgery Annual Scientific Meeting, April 30–May 4, 2016, Los Angeles, CA and American College of Surgeons-Ohio Chapter meeting, May 6–May 7, 2016 and selected as the first place in the Surgical Quality Poster section.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aydinli, H.H., Benlice, C., Ozuner, G. et al. Risk factors associated with postoperative morbidity in over 500 colovesical fistula patients undergoing colorectal surgery: a retrospective cohort study from ACS-NSQIP database. Int J Colorectal Dis 32, 469–474 (2017). https://doi.org/10.1007/s00384-016-2721-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-016-2721-4

Keywords

Search

Navigation