Risk factors for postoperative adverse outcomes in patients with high anal fistula undergoing modified TROPIS procedure combined with Parks’ fistulotomy with seton: a retrospective study - Summary - MDSpire
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Risk factors for postoperative adverse outcomes in patients with high anal fistula undergoing modified TROPIS procedure combined with Parks’ fistulotomy with seton: a retrospective study
To evaluate adverse outcomes and identify risk factors in patients undergoing modified TROPIS combined with Parks’ fistulotomy and seton for high anal fistula.
Key Findings:
Postoperative adverse outcomes occurred in 49 patients (22.5%).
Recurrence rate was 8.3%, incontinence 6.9%, delayed healing 10.1%, and major complications 3.7%.
Five independent risk factors identified: diabetes mellitus (adjusted OR 3.42, 95% CI 1.58–7.41), horseshoe extension (OR 2.98, 95% CI 1.45–6.12), internal sphincter incision >50% circumference (OR 2.76, 95% CI 1.32–5.78), operative time >60 min (OR 2.35, 95% CI 1.12–4.93), and BMI ≥ 28 kg/m2 (OR 2.08, 95% CI 1.05–4.12).
Model B demonstrated good discrimination (C-statistic 0.82, 95% CI 0.76–0.88; optimism-corrected 0.80) and outperformed Model A (0.74; p = 0.008).
Risk stratification identified 31.2% as high-risk with observed adverse outcome rates of 41.2% versus 14.0% in low-risk patients (p < 0.001).
Interpretation:
Limitations:
Findings require external validation in a larger cohort before clinical implementation.
Retrospective design may introduce bias, potentially affecting the reliability of the results.
