Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis
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 r...
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| Veröffentlicht in: | Diseases of the colon & rectum 2012-11, Vol.55 (11), p.1167-1172 |
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| creator | Fang, Sandy H Cromwell, John W Wilkins, Kirsten B Eisenstat, Theodore E Notaro, Joseph R Alva, Suraj Bustami, Rami Chinn, Bertram T |
| description | 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. |
| doi_str_mv | 10.1097/DCR.0b013e31826ab5e6 |
| format | Article |
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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.</description><identifier>ISSN: 0012-3706</identifier><identifier>EISSN: 1530-0358</identifier><identifier>DOI: 10.1097/DCR.0b013e31826ab5e6</identifier><identifier>PMID: 23044678</identifier><identifier>CODEN: DICRAG</identifier><language>eng</language><publisher>Hagerstown, MDc: The ASCRS</publisher><subject>Abdomen - surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Digestive System Surgical Procedures - adverse effects ; Digestive System Surgical Procedures - methods ; Digestive System Surgical Procedures - mortality ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Laparoscopy ; Logistic Models ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Other diseases. Semiology ; Perineum - surgery ; Rectal Prolapse - surgery ; Retrospective Studies ; Risk Assessment ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Young Adult</subject><ispartof>Diseases of the colon & rectum, 2012-11, Vol.55 (11), p.1167-1172</ispartof><rights>The ASCRS 2012</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4480-ad2d4da197984b7b643ebef6815c81447ceedb1c453b944f00f0a0bf7db275fd3</citedby><cites>FETCH-LOGICAL-c4480-ad2d4da197984b7b643ebef6815c81447ceedb1c453b944f00f0a0bf7db275fd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26470912$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23044678$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fang, Sandy H</creatorcontrib><creatorcontrib>Cromwell, John W</creatorcontrib><creatorcontrib>Wilkins, Kirsten B</creatorcontrib><creatorcontrib>Eisenstat, Theodore E</creatorcontrib><creatorcontrib>Notaro, Joseph R</creatorcontrib><creatorcontrib>Alva, Suraj</creatorcontrib><creatorcontrib>Bustami, Rami</creatorcontrib><creatorcontrib>Chinn, Bertram T</creatorcontrib><title>Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis</title><title>Diseases of the colon & rectum</title><addtitle>Dis Colon Rectum</addtitle><description>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.</description><subject>Abdomen - surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Digestive System Surgical Procedures - adverse effects</subject><subject>Digestive System Surgical Procedures - methods</subject><subject>Digestive System Surgical Procedures - mortality</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Logistic Models</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Other diseases. Semiology</subject><subject>Perineum - surgery</subject><subject>Rectal Prolapse - surgery</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Young Adult</subject><issn>0012-3706</issn><issn>1530-0358</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1v1DAQhi0EokvhHyDkCxKXlHHsxMkJrZaPrlTBsoVzZDtj1tSbLJ5EVf89Ll1YCV88M3rm6x3GXgq4ENDqt-9X2wuwICRK0ZS1sRXWj9hCVBIKkFXzmC0ARFlIDfUZe0b0M7tQgn7KzkoJStW6WbB5TXzaIV_aftyHwUS-xYMJiY8-W27KgU0aozkQ8mvjMWXaDHyDKQx4osPwp8pl-LFDmvg20A3fmCngMNE7vhz45-uv6002TLyjQM_ZE28i4Yvjf86-f_zwbXVZXH35tF4trwqnVAOF6cte9Ua0um2U1bZWEi36uhGVa4RS2iH2VjhVSdsq5QE8GLBe97bUle_lOXvzUPeQxl9znqzbB3IYoxlwnKnLQla1FK1QGVUPqEsjUULfHVLYm3SXoXtOd1nw7n_Bc9qrY4fZ7rH_l_RX4Qy8PgKGnIk-mcEFOnG10tCK8tT_dowTJrqJ8y2mbpdFnnYd5CfzmkWZTypE9gq4P6f8DaeBmRA</recordid><startdate>201211</startdate><enddate>201211</enddate><creator>Fang, Sandy H</creator><creator>Cromwell, John W</creator><creator>Wilkins, Kirsten B</creator><creator>Eisenstat, Theodore E</creator><creator>Notaro, Joseph R</creator><creator>Alva, Suraj</creator><creator>Bustami, Rami</creator><creator>Chinn, Bertram T</creator><general>The ASCRS</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201211</creationdate><title>Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis</title><author>Fang, Sandy H ; Cromwell, John W ; Wilkins, Kirsten B ; Eisenstat, Theodore E ; Notaro, Joseph R ; Alva, Suraj ; Bustami, Rami ; Chinn, Bertram T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4480-ad2d4da197984b7b643ebef6815c81447ceedb1c453b944f00f0a0bf7db275fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Abdomen - surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Digestive System Surgical Procedures - adverse effects</topic><topic>Digestive System Surgical Procedures - methods</topic><topic>Digestive System Surgical Procedures - mortality</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Logistic Models</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Other diseases. Semiology</topic><topic>Perineum - surgery</topic><topic>Rectal Prolapse - surgery</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fang, Sandy H</creatorcontrib><creatorcontrib>Cromwell, John W</creatorcontrib><creatorcontrib>Wilkins, Kirsten B</creatorcontrib><creatorcontrib>Eisenstat, Theodore E</creatorcontrib><creatorcontrib>Notaro, Joseph R</creatorcontrib><creatorcontrib>Alva, Suraj</creatorcontrib><creatorcontrib>Bustami, Rami</creatorcontrib><creatorcontrib>Chinn, Bertram T</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Diseases of the colon & rectum</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fang, Sandy H</au><au>Cromwell, John W</au><au>Wilkins, Kirsten B</au><au>Eisenstat, Theodore E</au><au>Notaro, Joseph R</au><au>Alva, Suraj</au><au>Bustami, Rami</au><au>Chinn, Bertram T</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis</atitle><jtitle>Diseases of the colon & rectum</jtitle><addtitle>Dis Colon Rectum</addtitle><date>2012-11</date><risdate>2012</risdate><volume>55</volume><issue>11</issue><spage>1167</spage><epage>1172</epage><pages>1167-1172</pages><issn>0012-3706</issn><eissn>1530-0358</eissn><coden>DICRAG</coden><abstract>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.</abstract><cop>Hagerstown, MDc</cop><pub>The ASCRS</pub><pmid>23044678</pmid><doi>10.1097/DCR.0b013e31826ab5e6</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0012-3706 |
| ispartof | Diseases of the colon & rectum, 2012-11, Vol.55 (11), p.1167-1172 |
| issn | 0012-3706 1530-0358 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1095631914 |
| source | MEDLINE; Journals@Ovid Complete |
| subjects | Abdomen - surgery Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Digestive System Surgical Procedures - adverse effects Digestive System Surgical Procedures - methods Digestive System Surgical Procedures - mortality Gastroenterology. Liver. Pancreas. Abdomen Humans Laparoscopy Logistic Models Medical sciences Middle Aged Multivariate Analysis Other diseases. Semiology Perineum - surgery Rectal Prolapse - surgery Retrospective Studies Risk Assessment Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Young Adult |
| title | Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis |
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