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

American Journal of Surgery
Vijaya T DanielKarim Alavi

Abstract

Many approaches to treat rectal prolapse exists, yet little is known regarding their safety in the elderly. 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. 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%. 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.

Citations

Sep 17, 2019·Postgraduate Medicine·Angela LeeBrooke Gurland
Nov 29, 2020·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·Sarah B JochumAnuradha R Bhama
Feb 5, 2021·Clinics in Colon and Rectal Surgery·Brooke Gurland, Kavita Mishra

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