Rectourethral fistulas: A comparison of the National Inpatient Sample and the American College of Surgeons National Surgical Quality Improvement Program

• Published in: The American journal of surgery 2017-04, Vol.213 (4), p.723-730.e4
• Main Authors: Schlussel, Andrew T., Lustik, Michael B., Delaney, Conor P., Stein, Sharon L., Reynolds, Harry L., Senagore, Anthony J., Johnson, Eric K., Steele, Scott R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Body mass index; Chronic obstructive pulmonary disease; Classification; Coding; Comorbidity; Datasets; Esophagus; Female; Fistula; Hospital Mortality; Hospitals; Humans; Inflammatory bowel disease; Intubation; Laparoscopy; Length of Stay - statistics & numerical data; Male; Medical personnel; Medicare; Middle Aged; Morbidity; Operative Time; Ostomy; Outcomes assessment; Patient Outcome Assessment; Patients; Postoperative Complications - epidemiology; Quality; Quality control; Quality improvement; Rectal Fistula - epidemiology; Rectal Fistula - surgery; Rectum; Registries; Retrospective Studies; Studies; Surgeons; Surgery; Trends; United States - epidemiology; Urethra; Urethral Diseases - epidemiology; Urethral Diseases - surgery; Urinary Fistula - epidemiology; Urinary Fistula - surgery; Urinary tract diseases; Urinary tract infections; Urogenital system; Weight control; Young Adult
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2016.08.009

The National Surgical Quality Improvement Program (NSQIP) and the National Inpatient Sample (NIS) may be used to evaluate outcomes for uncommon conditions such as rectourethral fistulas (RUFs). We sought to review cases of RUFs and compare variables from both registries to evaluate disparities among reported data. Review of NSQIP (2005-2013) and NIS (2006-2011) of all patients with a RUF or RUF repair based on ICD-9-CM or CPT coding. The NSQIP and NIS data sets were compared based on International Classification of Diseases, 9th Revision, Clinical Modification diagnosis coding for a RUF (599.1; American College of Surgeons National Surgical Quality Improvement Program: n = 286, NIS: n = 2,357). Comorbidities varied between data sets, and in-hospital morbidity in RUF cases was greater in the NIS vs NSQIP data sets (48% vs 11%; P < .01). Further analysis identified similar outcomes when cases of a RUF that underwent an operation were compared in the NSQIP (n = 284) and NIS (n = 274) database. This study represents the largest cohort of RUF cases and characterizes how using variables from both databases better elucidates details of this rare condition. These results exhibit how evaluating comparable metrics demonstrates inconsistencies between databases. •Demographics and outcomes are compared for rectourethral fistulas for two large databases.•Cases were identified based on ICD-9-CM and CPT codes.•This is the largest cohort of rectourethral fistula cases and identifies inconsistencies between the databases.