M. Patel1, K. Hoi1, K. DeCloux1, H. V. Tapia1, L. Maguire1 1University Of Michigan,Colorectal Surgery,Ann Arbor, MI, USA
Introduction: There are many surgical options for the treatment of rectal prolapse. Broadly, these options can be classified into perineal and abdominal approaches. There is a lack of high quality outcomes data, therefore choice of operation is likely based on surgeon/patient preferences. We describe national patterns in abdominal rectopexy, which is classically chosen as a low-recurrence option in younger, good risk patients.
Methods: Using the Nationwide Inpatient Sample years 2005-2014, we identified patients >18 years old, who had surgery during an elective, inpatient admission with a primary diagnosis of rectal prolapse (ICD-9 569.1). We described the overall trend in abdominal rectopexy over the 10-year span. We then identified factors associated with abdominal rectopexy including patient characteristics: race, age, all patient refined DRG risk of mortality (APRDRG-RM), and income; and hospital characteristics: urban/rural location and teaching status. We measured the average length of stay in each year throughout our study period. Data were weighted to generate national estimates.
Results: We identified 61,421 patients. Abdominal rectopexy from 35.6% of all rectal prolapse surgeries in 2004 to 43.7% in 2014. Over time period initial disparities by race and income resolved. In 2005, abdominal rectopexy was performed in 37% of white patients, but only 35% of black patients, 26.3% of Hispanic patients, and 33% of Asian patients. By 2014, abdominal rectopexy rose to greater than 46% in all three non-white groups compared to 41.9% in whites. Similarly in 2005, patients in the bottom 50% of median household income received abdominal rectopexy less often than those in the upper 50% (64.9% versus 77.7%). By 2014, rates were equivalent across income categories. Abdominal rectopexies were increasingly performed in sicker patients. Rates of abdominal rectopexy in the highest APRDRG-RM group increased from 21.6% to 50% (Figure 1). In terms of hospital factors, abdominal rectopexy was performed in the highest proportion in urban teaching hospitals from 2006-2010. By 2011, the rate in rural non-teaching hospitals (47.3%) was equivalent to that in urban non-teaching (46.2%) and urban teaching hospitals (41.3%). Finally, abdominal rectopexy length of stay decreased dramatically from 6.31 days to 4.8 days.
Conclusion: There was a substantial increase in the rate of abdominal rectopexy from 2005 to 2014. Specifically, abdominal rectopexy was adopted early at urban teaching hospitals and among white, higher income, lower risk patients, but over time, rates of abdominal rectopexy increased at rural, non-teaching hospitals, and among sicker and non-white patients.
