Repair failure and associated factors among women who underwent obstetric fistula surgery in Southwest Ethiopia: A retrospective study

Abstract

Background: Surgical repair is one of the management strategies for obstetric fistulae, which are associated with tragic obstetric morbidities. Objective: This study assessed the proportion of repair failures and associated factors among women who underwent obstetric fistula surgery at the Mettu Hamlin Fistula Center. Design: This study is an institution-based, retrospective, cross-sectional design. Methods: This study included 385 patients who underwent obstetric fistula repair surgery at the Mettu Hamlin Fistula Center between 2015 and 2020. Participants were selected using a simple random sampling technique. EpiData version 3.1 and STATA version 14.2 were used for data entry and analysis, respectively. The association between obstetric fistula failure and independent variables was tested using binary logistic regression analysis. In the bivariable analysis, a p-value of less than 0.25 was used as a cut-off point to include variables in the multivariable logistic regression analysis. The statistical significance was finally set at a p-value of less than 0.05. Results: Of the 385 participants who underwent obstetric fistula surgical repair, about 18.2% (95% confidence interval = 14.6–22.3) failed to close. Larger fistula size (>3 cm) (adjusted odds ratio (AOR) = 4.6; 95% confidence interval = 2.34–8.91), urethral damage (adjusted odds ratio = 2.8; 95% confidence interval = 1.47–5.44), home delivery (adjusted odds ratio = 5; 95% confidence interval = 2.56–9.77), and malnutrition (body mass index <18.5 kg/m2) (adjusted odds ratio = 2.7; 95% confidence interval = 1.10–6.79) were variables significantly associated with obstetric fistula repair failure. Conclusion: Obstetric fistula repair failure was lower in the area compared to the majority, but not all, of previous findings. Home delivery, damaged urethra, larger fistula size, and lower body mass index increased the probability of repair failure. To prevent repair failure early, it is necessary to strengthen pre- and post-operative care, including the assessment of women’s nutritional status, fistula size, and urethral injury. Moreover, maternal care providers should educate mothers about the negative outcomes of home deliveries.