Factors Related to Mortality in Colovesical Fistula Patients in Tertiary Care Hospital for 20 Years Experienced

Background: Colovesical fistula (CVF) is a rare but serious complication of intra-abdominal pathology, commonly resulting from diverticulitis, malignancy, or radiation.Management strategies vary, and the role of preoperative ostomy remains unclear in high-risk patients.Objective: To evaluate factors associated with mortality in CVF patients and examine the impact of preoperative ostomy on outcomes, particularly in relation to septic shock and SOFA scores.Methods: A retrospective review was conducted on 181 patients with CVF between 2000 and 2022.Patients were divided into three groups based on surgical management: palliative ostomy, multi-stage operation, and single-stage operation.Demographic data, clinical variables, SOFA scores, and mortality were analyzed using univariate and multivariate statistics.Results: Mortality was significantly associated with septic shock at admission and the use of palliative ostomy alone.Patients with SOFA scores >7 had markedly higher mortality rates, regardless of the surgical strategy employed.No significant differences in baseline comorbidities or demographics were observed across groups.Multivariate analysis identified septic shock (RR = 54.00;95% CI: 11.56-252.25;p < 0.001) and multi-stage operation (OR = 5.92; 95% CI: 1.83-19.09;p < 0.001) as independent predictors of mortality.Conclusions: Preoperative ostomy did not significantly reduce mortality in CVF patients with severe sepsis.SOFA score >7 was strongly predictive of poor outcome.Surgical planning should incorporate early risk stratification, and individualized management strategies are essential to improve survival in this high-risk population.