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UPJ Insight: Hypoalbuminemia Is Associated with Increased 30-Day Complications following Rectourethral Fistula Repair: A National Surgical Quality Improvement Program Study
By: M. Ryan Farrell, MD, MPH; Hocine Tighiouart, MS; Alex J. Vanni, MD | Posted on: 01 Mar 2022
Farrell MR, Tighiouart and Vanni AJ: Hypoalbuminemia is associated with increased 30-day complications following rectourethral fistula repair: a National Surgical Quality Improvement Program study. Urol Pract 2021; https://doi.org/10.1097/UPJ.0000000000000286.
Study Need and Importance: Rectourethral fistula (RUF) is a potentially devastating complication that can be managed with a variety of surgical approaches ranging from bowel and urinary diversion to reconstruction of the genitourinary tract. Among other related disciplines including colorectal surgery and cystectomy, hypoalbuminemia has been shown to impact outcomes and is associated with an increased incidence of postoperative complications.
Studies on risk factors for complications following surgical management of RUF are mostly limited to small, single institution series. This may be in part due to the relative rarity of RUF, which makes it a challenging entity to study. To date, population level data have not been utilized to evaluate postoperative complications and associated preoperative risk factors among men undergoing RUF surgery.
What We Found: This study described 30-day complications following surgery for RUF using the National Surgical Quality Improvement Program database. Further, risk factors for short-term postoperative complications were evaluated.
Table. Thirty-day adverse events among patients undergoing surgery for rectourethral fistula
| Complication | No. (%) |
|---|---|
| Overall pts | 250 |
| Wound infection | 14 (5.6) |
| Organ space infection | 11 (4.4) |
| Sepsis | 13 (5.2) |
| Urinary tract infection | 8 (3.2) |
| Venous thromboembolism | 8 (3.2) |
| Pneumonia | 3 (1.2) |
| Cerebrovascular accident | 0 (0) |
| Myocardial infarction | 0 (0) |
| Return to operating room | 19 (7.6) |
| Death | 5 (2.0) |
| Any complication | 51 (20.4) |
Any 30-day complication occurred in 20.4% of patients (see table). Hypoalbuminemia was identified in 19.8% of patients. On multivariable logistic regression, hypoalbuminemia was associated with increased odds of any 30-day adverse event (OR 2.49, 95% CI 1.06–5.86, p=0.036).
Limitations: The National Surgical Quality Improvement Program data set does not provide data on the type of RUF repair. Further, this data set does not contain information on adverse events beyond 30-days postoperatively and does not have variables that describe fistula etiology, surgical technique, surgeon experience or RUF recurrence.
Interpretation for Patient Care: Similar to patients undergoing colorectal surgery and cystectomy, hypoalbuminemia may have an association with postoperative complications following surgical management of RUF. Identification of preoperative hypoalbuminemia can be a useful tool when counseling patients about the risk of short-term postoperative adverse events. Further study is warranted to elucidate the role of hypoalbuminemia in RUF surgical complications and outcomes, and whether preoperative nutritional supplementation is beneficial.