Risk factors for perioperative blood transfusions after urogenital
fistula repair in Uganda: a retrospective cohort study
Abstract
Objective: To determine the incidence of and risk factors for
perioperative blood transfusions after urogenital fistula repairs in
Uganda. Design: A retrospective cohort study. Setting: A community
hospital in Masaka, Uganda. Population: Women who underwent fistula
repair at the Kitovu Hospital between 2013 and 2019. Methods:
Retrospective review of demographics, and clinical perioperative
characteristics of patients surgically treated for urogenital fistula.
Patient characteristics were compared between those who did and did not
require a blood transfusion. Main Outcome Measures: need for
perioperative blood transfusion, risk factors Results: 546 patients
treated for urogenital fistulas were included in this study. The median
age was 31.1 ± 13.2. A vaginal surgical approach was used in the
majority of patients (84.6%). Complications occurred in 3.5% of
surgical repairs, and the incidence of blood transfusions was 6.2%. In
multivariable analyses, women with fistula repairs approached
abdominally were 4.3 (95% CI: 1.85–10.00) times more likely to require
transfusions than vaginal operations. A borderline association was
observed between timing of repair and perioperative transfusions such
that patients who underwent repair after three months from the time of
developing the fistula were at lower risk of perioperative transfusions
(aOR: 0.48, 95% CI: 0.22–1.04). Conclusions: The incidence of blood
transfusions among urogenital fistula repairs in our population is twice
that of developed nations. An abdominal surgical approach to urogenital
fistula is a significant risk factor for perioperative blood
transfusions. Timing of repair may warrant further study.