Getting to the bottom of treatment of rectal prolapse in the elderly: Analysis of the National Surgical Quality Improvement Program (NSQIP)

Vijaya T. Daniel, Jennifer S. Davids, Paul R. Sturrock, Justin A. Maykel, Uma R. Phatak, Karim Alavi

Research output: Contribution to journalArticle

Abstract

Background: Many approaches to treat rectal prolapse exists, yet little is known regarding their safety in the elderly. Method: NSQIP (2008–2014) was queried to identify patients ≥ 70 years who underwent open rectopexy (OR), laparoscopic rectopexy (LR) and perineal rectosigmoidectomy (PR). Patients were selected using NSQIP's estimated probability of morbidity of ≥50th percentile. Outcomes were 30-day mortality and a composite: mortality, septic shock and organ space abscess and fascial dehiscence. Results: Overall, 1361 patients underwent OR(18%), LR(15%) and PR(67%) with no difference in outcomes among 3 approaches. After adjustment of other factors, the composite was associated with PR [OR 2.5, CI 1.1, 5.7] and not with older age [OR 1.3, (CI) 0.7, 2.4]. From 2008 to 2014, LR increased from 11% to 19%; and PR decreased from 75% to 72%. Conclusions: All 3 surgical approaches carry low morbidity among the sick, elderly. PR remains the predominant approach nationally. A paradigm shift accepting the safety of abdominal approaches is needed. There should also be less focus on age in the decision-making process of surgical treatment.

Original languageEnglish (US)
Pages (from-to)288-292
Number of pages5
JournalAmerican Journal of Surgery
Volume218
Issue number2
DOIs
StatePublished - Aug 2019
Externally publishedYes

Keywords

  • Elderly
  • Outcomes
  • Rectal prolapse treatment

ASJC Scopus subject areas

  • Surgery

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