EP382 - Outcomes After Emergent Surgery for Rectal Prolapse - A NSQIP Analysis

Purpose/Background: Rectal prolapse is a clinically significant condition that may require emergent surgical intervention, particularly in cases with concern for strangulation. Despite the clinical importance of this pathology, there is a paucity of large-scale data examining the risk factors and perioperative outcomes associated with it. This study aimed to characterize and compare short-term outcomes for patients undergoing emergent versus elective surgery for rectal prolapse.

Methods/Interventions: The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database was queried for cases from 2012 to 2023. Patients aged ≥18 years who underwent open or minimally invasive rectopexy, with or without sigmoidectomy, or perineal proctosigmoidectomy were identified using current procedural terminology (CPT) codes. Short-term postoperative outcomes were compared between elective and emergent procedures. A composite outcome of major complications was used. Univariate and multivariate logistic regression analyses were performed.

Results/Outcomes: Among 16,750 patients who underwent surgery, 8.7% (n=1,462) were emergent and 91.3% (n=15,288) were elective. Patients undergoing emergent surgery were older (mean age 73 years), more frequently female and White, and had higher ASA scores. Surgical approach differed between groups. Emergent cases most commonly involved perineal procedures (66.8% vs 43.5%), while minimally invasive (18.9% vs 40.5%) and open approaches (14.3% vs 16.0%) were more frequent in elective cases (p < 0.001). Emergent surgeries had shorter operative times (113 vs 130 minutes, p< 0.001) but resulted in longer hospital stays (7 vs 3 days, p< 0.001).

When comparing 30-day postoperative complications, emergent cases had higher rates of readmission (12.7% vs 6.4%, p< 0.001) and reoperation (5.8% vs 2.9%, p< 0.001). The emergent patients also experienced higher rates of sepsis (2.4% vs 0.8%, p< 0.001), pneumonia (3.1% vs 0.7%, p< 0.001), cerebrovascular accidents (0.6% vs 0.1%, p< 0.001), myocardial infarction (1.0% vs 0.4%, p=0.002), cardiac arrest requiring CPR (0.7% vs 0.1%, p< 0.001), organ space infection (4.0% vs 1.6%, p< 0.001), and overall major complications (4.8% vs 1.3%, p< 0.001).

On multivariable analysis, emergent surgery was independently associated with 2.83-fold increased odds of major complications (95% CI 2.4-5.0, p< 0.001) and 3.49-fold increased odds of 30-day mortality (95% CI 2.1-3.8, p< 0.001) compared to elective procedure.

Conclusion/Discussion: Emergent surgery for rectal prolapse was associated with higher morbidity and 30-day mortality. These findings underscore the importance of preoperative optimization and timely surgical evaluation for patients with rectal prolapse. A proactive approach to elective management may reduce the need for emergent intervention and improve overall patient outcomes.

Post-operative Outcomes after Emergent vs. Elective Rectal Prolapse Repair