title: Is the abdominal repair of rectal prolapse safer than perineal repair in the highest risk patients? An NSQIP analysis.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 3 and 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA. fangsh77@gmail.com
authors.forename: Sandy H
authors.initials: SH
authors.lastname: Fang
authors.forename: John W
authors.initials: JW
authors.lastname: Cromwell
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Wilkins
authors.forename: Theodore E
authors.initials: TE
authors.lastname: Eisenstat
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Notaro
authors.forename: Suraj
authors.initials: S
authors.lastname: Alva
authors.forename: Rami
authors.initials: R
authors.lastname: Bustami
authors.forename: Bertram T
authors.initials: BT
authors.lastname: Chinn
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010502:Perineum / Q000601:surgery*; D012005:Rectal Prolapse / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult