Obstetric fistula scoring tool for surgical trainees. Issue 3 (9th June 2021)

• Record Type: Journal Article
• Authors: Pope, Rachel; Mernoff, Rachel; Chalamanda, Chisomo; Bengtson, Angela M.
• Is Part Of: International journal of gynaecology and obstetrics. Volume 156:Issue 3(2022)
• Page Start: 502
• Page End: 507
• Publication Date: 2021-06-09
• Subjects: incontinence -- obstetric fistula -- surgical scoring -- trainees -- vesicovaginal fistula; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1002/ijgo.13693
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: Objective: To examine the ability of a previously published risk score to predict incontinence at discharge in women with vesicovaginal fistulas (VVF) and to examine how the score correlates with an independent assessment of surgical skill. Methods: This is a retrospective cohort study including cases from January to June 2018. We evaluated operative records for factors associated with incontinence at hospital discharge, as well as relationships between a risk score cut‐point of 20 or more and surgical skill level. All women with VVF undergoing vaginal repair were included. Results: A total of 176 individuals underwent repair; 23 were performed by beginner, 85 by intermediate, 47 by advanced, and 21 by expert surgeons. Factors found significantly associated with incontinence at hospital discharge included Goh classification, fistula size, circumferential fistula, and vaginal scarring. A score of 20 or more predicted residual incontinence with a negative predictive value of 92% (odds ratio 7.75, 95% confidence interval 2.95–22.34). Applying the score cut‐point of 20 or more, we found an increased proportion of "high‐risk" cases allocated to surgeons with an increasing level of expertise. Conclusion: The correlation we observed between a risk score cut‐point of 20 or more, continence status, and an independent assessment of surgical skill is promising. Although the risk score is not meant to replace clinical judgment, it may provide a surgical trainee with an objective method of determining whether to operate or refer for optimal outcomes. Abstract : A risk score predicting postoperative incontinence among women with obstetric fistula may be able to inform referral of high‐risk patients to experienced surgeons.