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Mortality risk associated with surgical treatment of female genital fistula
Author(s) -
Ruminjo Joseph,
Landry Evelyn,
Beattie Karen,
Isah Adamu,
Faisel Abu Jamil,
Millimono Sita
Publication year - 2014
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2014.02.015
Subject(s) - medicine , case fatality rate , referral , medical record , fistula , audit , perioperative , mortality rate , sepsis , general surgery , surgery , emergency medicine , epidemiology , family medicine , management , economics
Objective To describe the mortality risk associated with surgical treatment of female genital fistula and the contributory and contextual factors. Methods In a descriptive study, confidential inquiries and clinical audits were conducted at 14 fistula repair sites in seven resource‐poor countries between January 2005 and March 2013. Data collection included interviews with key personnel involved in the clinical management of the deceased, and a review of hospital records and patient files following an audit protocol. Results Overall, 26 060 fistula repairs were performed at 44 sites located in 13 countries; 30 deaths were reported in this period. Twenty‐one deaths were attributable to surgery, yielding a case fatality of 0.08 per 100 procedures. The cause of death in nearly half of the cases was various manifestations of sepsis and inflammation. Conclusion The case fatality rate for fistula repair surgery in resource‐poor countries was in the same range as that for comparable gynecologic operations in high‐resource settings. Clinical and systemic issues to be addressed to reduce the case fatality rate include improvement of perioperative care and follow‐up, assuring prudent referral or deferral of difficult cases, and maintaining better records.