How accurate are published recurrence rates after rectal prolapse surgery? A meta-analysis of individual patient data.
BACKGROUND
The literature shows wide variations of recurrence rates (RRs) after abdominal surgery for rectal prolapse. The aim of this meta-analysis was to evaluate the accuracy of published RRs.


METHODS
An electronic search was performed with no restrictions. Inclusion criterion was abdominal surgery in at least 10 adults with follow-up evaluation of any length of time. Two reviewers screened 1669 references. A total of 190 investigators were asked to provide individual patient data that should be the same used at the time their reports were written. The RR was estimated by actuarial analysis. Investigators were asked for comments on results.


RESULTS
Individual patient data from 6 reports published with 273 patients (186 women, 87 men) with a median age of 54 years (range, 18-88 y) were available. Abdominal surgery included mobilization with pexy (88%), with additional resection (7%), or mobilization only (5%). There were 16 recurrences at a median follow-up period of 3.94 years (range, .05-15.11 y). The effect of age (hazard ratio [HR], 2.010; P = .3443), sex (HR, 2.070; P = .4260), surgical technique (HR, .743; P = .7669), and publication (HR, 1.014; P = .8747) on RR was not significant. Two publications reported a RR of 0. In another report, the published and estimated RRs of 15% did not differ. Published RRs differed from estimated RRs in 3 reports (2.5% vs 4%; 7% vs 54%; and 9.6% vs 36%). The pooled odds ratios of 6 reports revealed a borderline significant difference between the published and estimated RRs (P = .066).


CONCLUSIONS
Published RRs differed by as much as 47% from the RRs estimated by actuarial analysis depending on event definition and how the data were censored.
DiGiuro
Giuseppe
G
Department of Research and Development, Forde Health System, Forde, Norway 6807.
Ignjatovic
Dejan
D
Brogger
Jan
J
Bergamaschi
Roberto
R
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011336:Probability; D012005:Rectal Prolapse / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D017678:Sex Distribution