alexa Developing a Simple Proof of Concept Clinical Decision-Making Tool for Predicting Surgical Outcomes after Obstetric Fistula Repair in a Developing Country
ISSN: 2329-9088

Tropical Medicine & Surgery
Open Access

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Research Article

Developing a Simple Proof of Concept Clinical Decision-Making Tool for Predicting Surgical Outcomes after Obstetric Fistula Repair in a Developing Country

Bio Tamou Sambo1,2*, Celestin Missikpode3, Kabibou Salifou4, Adrien Hodonou2, Emile Mensah2, Alexandre Allode2, Christian Johnson3, Audrey Saftlas3 and Robert Wallace3

1Bembereke Hospital BP 28 Bembereke, Benin

2Department of Surgery, School of Medicine, University of Parakou, B.P. 123 Parakou, Benin

3Department of Epidemiology, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA

4Department of Obstetrics and Gynecology, School of Medicine, University of Parakou, B.P. 123 Parakou, Benin

Corresponding Author:
Bio Tamou Sambo, MD
Assistant Professor, School of Medicine
Teaching Hospital of Parakou
University of Parakou, B.P. 123 Parakou, Benin
Tel: +(229)97653888/+(229)64759393
E-mail: [email protected]

Received date: March 25, 2016; Accepted date: May 16, 2016; Published date: May 20, 2016

Citation: Tamou SB, Missikpode C, Salifou K, Hodonou A, Mensah E, et al. (2016) Developing a Simple Proof of Concept Clinical Decision- Making Tool for Predicting Surgical Outcomes after Obstetric Fistula Repair in a Developing Country. Trop Med Surg 4:209. doi:10.4172/2329-9088.1000209

Copyright: © 2016 Tamou SB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Abstract

Introduction: Obstetric fistula is a serious injury resulting from obstructed labor causing significant maternal morbidity in women in developing countries. In order to maximize probability of successful surgical repair, it is important to identify women at-risk for poor surgical outcomes so that they can be given appropriate care. The goal of this study is to explore additional factors associated with fistula repair outcomes, as well as determine whether statistical modeling can be used to create a clinical decision-making tool for predicting a successful repair.

Methods: Medical records for 82 patients surgically treated for obstetric fistula in Benin were retrospectively reviewed to collect demographic and clinical information related to their condition and procedure. Individuals were grouped into 3 main outcomes: successful closure with continence, successful closure with residual incontinence, and failed repair. A backwards stepwise selection methodology and logistic regression were used to select factors and examine their associations with the surgical outcomes. Structural equation modelling was used to develop a prediction tool for successful repair.

Results: Location of fistula (vesicovaginal, vesicouterine, ureteroalvaginal, ureterouterine, and rectovaginal) (OR=7.6 (2.39, 24.36)), being married (OR=3.45 (1.09, 10.90)), parity of 1 to 3 (OR=2.99 (0.94, 9.49)), duration of fistula less than 10 years (OR=2.07 (0.88, 8.25)), and no previous repair attempt (OR=2.40 (0.79, 7.25)) were found to favor a successful closure with continence. We developed a prediction tool to sort women with obstetric fistula into 5 different categories based on probability of success. Our model suggests that marital status affects successful repair through a mediating factor not yet identified.

Conclusion: This study classified fistulous women into clinically relevant categories based on the probability of a successful repair. The results from the present study may inspire further research on identifying fistulas with poor prospect of success, which might benefit from more specialized care.

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