Patterns and Outcomes of Elective versus Non-Elective Rectal Prolapse Repair: an ACS-NSQIP Analysis

BACKGROUND: There is a paucity of knowledge regarding the presentation, surgical management, and short-term outcomes of rectal prolapse in the non-elective setting. OBJECTIVE: The objectives of this study were to evaluate the short-term postoperative outcomes following non-elective surgery for rectal prolapse and to compare those outcomes to patients who underwent elective repair. DESIGN: Retrospective cohort study. SETTINGS: Multicenter North American database. PATIENTS: Adult (18 years-old or above) who underwent surgery for rectal prolapse. INTERVENTIONS: Non-elective surgery (vs. elective surgery). MAIN OUTCOME MEASURES: Co-primary outcomes included 30-day postoperative morbidity, mortality, re-operation, and unplanned hospital readmission. RESULTS: In total, 17,836 patients underwent surgery for rectal prolapse and were followed for 30 days postoperatively: 1,636 (9.2%) non-elective and 16,200 (90.8%) elective. Patients who underwent non-elective surgery were older (age 85+: 29.5% vs. 13.9%, p < 0.001), more likely to be functionally dependent (16.8% vs. 6.3%, p < 0.001), and were more likely to undergo a perineal approach (59.7% vs. 40.7%, p < 0.001). On multiple logistic regression, non-elective surgery was independently associated with 30-day postoperative morbidity (aOR: 2.16, 95% CI 1.87-2.48), mortality (aOR: 2.97, 95% CI: 2.10-4.14), re-operation (aOR: 1.89, 95% CI: 1.49-2.39) and unplanned hospital readmission (aOR: 1.87, 95% CI: 1.57-2.20). Furthermore, when stratified by surgical approach (perineal vs. abdominal), non-elective surgery remained associated with a similar increase in postoperative risk across all outcomes. Among 1,636 non-elective cases, 237 (14.5% of non-elective cases) underwent emergent surgery and 1,399 (85.5% of non-elective cases) underwent non-emergent (or urgent) surgery. As compared to non-emergent surgery, emergent surgery for rectal prolapse was associated with an incrementally higher risk of 30-day postoperative morbidity (25.7% vs. 19.6%, p = 0.030) and mortality (6.3% vs. 3.3%, p = 0.022). LIMITATIONS: No data on previous repairs and/or hospital visits related to rectal prolapse. CONCLUSIONS: Non-elective rectal prolapse surgery was associated with significantly worse 30-day postoperative outcomes as compared to elective repair. See Video Abstract .