Document Detail


Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis.
MedLine Citation:
PMID:  23044678     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: : 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 3and 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.
Authors:
Sandy H Fang; John W Cromwell; Kirsten B Wilkins; Theodore E Eisenstat; Joseph R Notaro; Suraj Alva; Rami Bustami; Bertram T Chinn
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1167-72     Citation Subset:  IM    
Affiliation:
1Division of Colon and Rectal Surgery, Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson University Hospital, New Brunswick, New Jersey 2Division of Gastrointestinal Surgery, Minimally-Invasive and Bariatric Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 3Division of Biostatistics, Atlantic Health System, Morristown, New Jersey.
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