Impact of Emergent Inpatient Hospital Utilization among Rectal Prolapse Patients: A Nationwide Cohort Analysis

BACKGROUND: Rectal prolapse is a condition most prevalent among older women that impacts daily quality of life. Current national guidelines recommend elective multidisciplinary management for rectal prolapse care. Despite these recommendations, little is known about the frequency and predisposing factors of emergent rectal prolapse admissions or their associated outcomes. OBJECTIVE: To quantify emergent admission rates among people with rectal prolapse, compare outcomes of emergent v. elective admissions, and identify factors associated with emergent admission. DESIGN: Retrospective cohort analysis. SETTINGS: Nationwide inpatient Sample, 2017 to 20. PATIENTS: Adults aged 18 years and older admitted with a diagnosis of rectal prolapse. MAIN OUTCOME MEASURES: Primary exposure was admission type (emergent vs elective). Primary outcomes included length of stay, in-hospital mortality, and discharge disposition. Secondary outcomes included performance of rectal prolapse repair and operative approach. RESULTS: A total of 7,555 adult patients were admitted with a diagnosis of rectal prolapse. Of these, 1,681 (22.2%) admissions were emergent. Emergent admissions were associated with longer length of stay, higher in-hospital mortality, lower likelihood of discharge home, and greater need for postacute care. Surgical intervention was less common among emergent admissions, and perineal procedures were more common. On multivariable analysis, older age, Black and Hispanic race, Medicare, Medicaid and self-pay status, homelessness, lower neighborhood income, schizophrenia, substance use disorder, eating disorder, dementia, intellectual disability, and higher comorbidity burden were independently associated with emergent admission. Female sex and depression were associated with lower odds of emergent admission. LIMITATIONS: The database captures inpatient hospitalizations only and diagnoses and procedures are identified using administrative billing codes. CONCLUSIONS: Emergent admissions accounted for a substantial number of rectal prolapse hospitalizations nationally and were associated with socioeconomic vulnerability, multimorbidity, psychiatric and cognitive conditions, and worse clinical outcomes. These findings highlight existing differences in healthcare utilization for this surgical patient population. See Video Abstract.