TY - JOUR
T1 - Getting to the bottom of treatment of rectal prolapse in the elderly
T2 - Analysis of the National Surgical Quality Improvement Program (NSQIP)
AU - Daniel, Vijaya T.
AU - Davids, Jennifer S.
AU - Sturrock, Paul R.
AU - Maykel, Justin A.
AU - Phatak, Uma R.
AU - Alavi, Karim
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/8
Y1 - 2019/8
N2 - 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.
AB - 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.
KW - Elderly
KW - Outcomes
KW - Rectal prolapse treatment
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U2 - 10.1016/j.amjsurg.2019.02.010
DO - 10.1016/j.amjsurg.2019.02.010
M3 - Article
C2 - 30803700
AN - SCOPUS:85061833835
SN - 0002-9610
VL - 218
SP - 288
EP - 292
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 2
ER -