Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis

Sandy H Fang, John W. Cromwell, Kirsten B. Wilkins, Theodore E. Eisenstat, Joseph R. Notaro, Suraj Alva, Rami Bustami, Bertram T. Chinn

Research output: Contribution to journalArticle

Abstract

Although the perineal approach in the surgical management of rectal prolapse has a higher recurrence, it is the accepted approach for higher-risk patients because of its lower morbidity. OBJECTIVE: The aim of this study was to determine outcomes of abdominal versus perineal approaches to rectal prolapse repair. DESIGN SETTINGS: A retrospective study was performed comparing outcomes of patients undergoing different types of surgical approaches (open abdominal, laparoscopic, perineal) for rectal prolapse. PATIENTS: The American College of Surgeons National Surgical Quality Improvement Participant User Data Files (2008-2009) were queried for patients undergoing adult, elective procedures for rectal prolapse. MAIN OUTCOME MEASURES: Univariate analysis and multivariate logistic regression were performed to look at age, ASA classification, procedure type, and resultant mortality rate. RESULTS: One thousand four hundred sixty-nine patients meeting our criteria were identified. Older patients (age >80) and higher-risk patients (ASA classifications 3 and 4) were significantly associated with the selection of the perineal approach. The overall mortality rate was 0.5%. The mortality rate for all perineal procedures was 0.9% in comparison with 0.13% for all abdominal operations (p = 0.033). The mortality rate for the highest-risk groups (ASA 3 and 4) for perineal procedures was 1.3% in comparison with 0.35% in the abdominal procedure group; the relative risk for mortality was 4 times greater in the perineal procedure group than in the abdominal procedure group. LIMITATIONS: The retrospective design and standardized outcomes measured use administrative-level data and prevent the assessment of procedure-specific outcomes. CONCLUSIONS: Hospital mortality for the surgical repair of rectal prolapse is uncommon. The decision to choose the abdominal approach for the repair of rectal prolapse may not be as prohibitive as previously thought for higher-risk patients. Because of the broad range of functionality within each ASA classification, the operation offered should always be individualized, and patient selection is the most important factor.

Original languageEnglish (US)
Pages (from-to)1167-1172
Number of pages6
JournalDiseases of the Colon and Rectum
Volume55
Issue number11
DOIs
StatePublished - Nov 2012
Externally publishedYes

Fingerprint

Rectal Prolapse
Mortality
Information Storage and Retrieval
Quality Improvement
Hospital Mortality
Patient Selection
Multivariate Analysis
Retrospective Studies
Logistic Models
Morbidity
Recurrence

Keywords

  • Abdominal approach
  • American College of Surgeons National Surgical Quality Improvement Program
  • Mortality
  • Perineal approach
  • Rectal prolapse

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis. / Fang, Sandy H; Cromwell, John W.; Wilkins, Kirsten B.; Eisenstat, Theodore E.; Notaro, Joseph R.; Alva, Suraj; Bustami, Rami; Chinn, Bertram T.

In: Diseases of the Colon and Rectum, Vol. 55, No. 11, 11.2012, p. 1167-1172.

Research output: Contribution to journalArticle

Fang, Sandy H ; Cromwell, John W. ; Wilkins, Kirsten B. ; Eisenstat, Theodore E. ; Notaro, Joseph R. ; Alva, Suraj ; Bustami, Rami ; Chinn, Bertram T. / Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis. In: Diseases of the Colon and Rectum. 2012 ; Vol. 55, No. 11. pp. 1167-1172.
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abstract = "Although the perineal approach in the surgical management of rectal prolapse has a higher recurrence, it is the accepted approach for higher-risk patients because of its lower morbidity. OBJECTIVE: The aim of this study was to determine outcomes of abdominal versus perineal approaches to rectal prolapse repair. DESIGN SETTINGS: A retrospective study was performed comparing outcomes of patients undergoing different types of surgical approaches (open abdominal, laparoscopic, perineal) for rectal prolapse. PATIENTS: The American College of Surgeons National Surgical Quality Improvement Participant User Data Files (2008-2009) were queried for patients undergoing adult, elective procedures for rectal prolapse. MAIN OUTCOME MEASURES: Univariate analysis and multivariate logistic regression were performed to look at age, ASA classification, procedure type, and resultant mortality rate. RESULTS: One thousand four hundred sixty-nine patients meeting our criteria were identified. Older patients (age >80) and higher-risk patients (ASA classifications 3 and 4) were significantly associated with the selection of the perineal approach. The overall mortality rate was 0.5{\%}. The mortality rate for all perineal procedures was 0.9{\%} in comparison with 0.13{\%} for all abdominal operations (p = 0.033). The mortality rate for the highest-risk groups (ASA 3 and 4) for perineal procedures was 1.3{\%} in comparison with 0.35{\%} in the abdominal procedure group; the relative risk for mortality was 4 times greater in the perineal procedure group than in the abdominal procedure group. LIMITATIONS: The retrospective design and standardized outcomes measured use administrative-level data and prevent the assessment of procedure-specific outcomes. CONCLUSIONS: Hospital mortality for the surgical repair of rectal prolapse is uncommon. The decision to choose the abdominal approach for the repair of rectal prolapse may not be as prohibitive as previously thought for higher-risk patients. Because of the broad range of functionality within each ASA classification, the operation offered should always be individualized, and patient selection is the most important factor.",
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AU - Eisenstat, Theodore E.

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AB - Although the perineal approach in the surgical management of rectal prolapse has a higher recurrence, it is the accepted approach for higher-risk patients because of its lower morbidity. OBJECTIVE: The aim of this study was to determine outcomes of abdominal versus perineal approaches to rectal prolapse repair. DESIGN SETTINGS: A retrospective study was performed comparing outcomes of patients undergoing different types of surgical approaches (open abdominal, laparoscopic, perineal) for rectal prolapse. PATIENTS: The American College of Surgeons National Surgical Quality Improvement Participant User Data Files (2008-2009) were queried for patients undergoing adult, elective procedures for rectal prolapse. MAIN OUTCOME MEASURES: Univariate analysis and multivariate logistic regression were performed to look at age, ASA classification, procedure type, and resultant mortality rate. RESULTS: One thousand four hundred sixty-nine patients meeting our criteria were identified. Older patients (age >80) and higher-risk patients (ASA classifications 3 and 4) were significantly associated with the selection of the perineal approach. The overall mortality rate was 0.5%. The mortality rate for all perineal procedures was 0.9% in comparison with 0.13% for all abdominal operations (p = 0.033). The mortality rate for the highest-risk groups (ASA 3 and 4) for perineal procedures was 1.3% in comparison with 0.35% in the abdominal procedure group; the relative risk for mortality was 4 times greater in the perineal procedure group than in the abdominal procedure group. LIMITATIONS: The retrospective design and standardized outcomes measured use administrative-level data and prevent the assessment of procedure-specific outcomes. CONCLUSIONS: Hospital mortality for the surgical repair of rectal prolapse is uncommon. The decision to choose the abdominal approach for the repair of rectal prolapse may not be as prohibitive as previously thought for higher-risk patients. Because of the broad range of functionality within each ASA classification, the operation offered should always be individualized, and patient selection is the most important factor.

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KW - American College of Surgeons National Surgical Quality Improvement Program

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