LUSSY score predictive of failure of surgical closure of obstetric rectovaginal fistula in the Democratic Republic of the Congo.

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Reproductive Health Pub Date : 2025-03-12 DOI:10.1186/s12978-025-01971-w

Justin Lussy Paluku, Franck Katembo Sikakulya, Cathy Mufungizi Furaha, Eugénie Mukekulu Kamabu, Olivier Mukuku, Zacharie Kibendelwa Tsongo, Stanis Okitotsho Wembonyama, Charles Wembonyama Mpoy, Jeannot Sihalikyolo Juakali

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引用次数: 0

Abstract

Introduction: Rectovaginal fistula (RVF) is a complex debilitating condition that results from several etiologies, obstetric trauma being the most common. Occasionally RVF closure is non-successful. The objective of this study is to develop a predictive score to identify predictors of failure of surgical closure of obstetric RVF (FSCORVF) in the Democratic Republic of the Congo.

Methods: This was an analytical cross-sectional study conducted on 268 patients with obstetric RVF who have received surgical management. We proceeded with a bivariate and then multivariate analysis. Score discrimination was assessed using the ROC curve and C-index and score calibration was done according to the Hosmer-Lemeshow test.

Results: Surgical closure of RVF failed in 12.31% of cases (33/268). After logistic modelling, five criteria emerged as predictive factors of FSCORVF (LUSSY Score): the presence of moderate/severe fibrosis (aOR: 36.25; 95% CI: 1.88-699.37), combined RVF with other type of fistula (aOR: 61.41; 95% CI: 8.78-429.72), fistula size > 3 cm (aOR: 82.45; 95% CI: 10.48-648.58), per-operative hemorrhage (aOR: 27.84;; 95% CI: 5.08-152.47) and postoperative infection (aOR: 1161.35; 95% CI: 46.89-28765.47). A score of 0 to 22 was obtained with a value ≤ 9 points indicating a low risk of FSCORVF, a value between 10 and 12 defining a moderate risk and the value ≥ 13 points corresponding to a high risk of FSCORVF. The area under the ROC curve of the score is 0.9744 with a sensitivity of 90.91%, a specificity of 97.87%, a positive predictive value of 85.71% and a negative predictive value of 98.71%.

Conclusion: This study identified predictive factors for FSCORVF in the DRC, grouped in the LUSSY score. Complex fistulas (fistula size > 3 cm, severe fibrosis, combined fistulas) require advanced surgical routes different from the transvaginal and the transperineal ones used in the present study. Prevention of intraoperative hemorrhage and postoperative infections requires rigorous preparation, appropriate antibiotic prophylaxis, and strict postoperative follow-up.

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LUSSY评分在刚果民主共和国预测手术关闭产科直肠阴道瘘失败。

直肠阴道瘘（RVF）是一种复杂的衰弱疾病，由多种病因引起，产科创伤是最常见的。有时封闭裂谷热不成功。本研究的目的是制定一个预测评分，以确定刚果民主共和国产科裂谷热（FSCORVF）手术关闭失败的预测因素。方法：这是一项对268例接受手术治疗的产科裂谷热患者进行的分析性横断面研究。我们进行了双变量和多变量分析。采用ROC曲线和c指数评定评分区分度，采用Hosmer-Lemeshow检验进行评分校正。结果：裂谷热手术治疗失败率为12.31%（33/268）。logistic建模后，出现了五个标准作为FSCORVF （LUSSY评分）的预测因素：存在中度/重度纤维化(aOR: 36.25；95% CI: 1.88-699.37)，裂谷热合并其他类型瘘管(aOR: 61.41；95% CI: 8.78-429.72)，瘘管大小bbbb3 cm (aOR: 82.45；95% CI: 10.48-648.58)，术中出血(aOR: 27.84;；95% CI: 5.08-152.47)和术后感染(aOR: 1161.35；95% ci: 46.89-28765.47)。评分范围为0 ~ 22分，≤9分为低风险，10 ~ 12分为中度风险，≥13分为高风险。评分的ROC曲线下面积为0.9744，灵敏度为90.91%，特异性为97.87%，阳性预测值为85.71%，阴性预测值为98.71%。结论：本研究确定了刚果民主共和国FSCORVF的预测因素，按LUSSY评分分组。复杂瘘管（瘘管大小为bbb30 - 3cm，严重纤维化，合并瘘管）需要不同于本研究中经阴道和经会阴的先进手术路径。预防术中出血和术后感染需要严格的准备，适当的抗生素预防和严格的术后随访。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reproductive Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.00

自引率

5.90%

发文量

220

审稿时长

>12 weeks

期刊介绍： Reproductive Health focuses on all aspects of human reproduction. The journal includes sections dedicated to adolescent health, female fertility and midwifery and all content is open access. Reproductive health is defined as a state of physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. Good reproductive health implies that people are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when, and how often to do so. Men and women should be informed about and have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth.