EP734 - Patterns and Outcomes of Elective versus Non-Elective Rectal Prolapse Repair: an ACS-NSQIP Analysis

Purpose/Background: Rectal prolapse is commonly managed with an elective surgical repair. However, a subset of patients do undergo non-elective repair, either due to refractory, life-altering symptoms requiring urgent surgery or complications such as incarceration and/or strangulation. There is a paucity of data available regarding the presentation and surgical management of rectal prolapse in the non-elective setting. The objectives of this study were to compare patient characteristics, operative approaches, and postoperative outcomes between elective and non-elective rectal prolapse repair using a large multicenter database.

Methods/Interventions: This was an observational cohort study using data from the ACS-NSQIP general dataset between the years 2011-2023. All adult patients who underwent surgery for rectal prolapse according to relevant procedural codes for both abdominal and perineal repairs were included. The primary exposure was case acuity, defined as elective or non-elective (urgent and/or emergent). Several 30-day postoperative outcomes were evaluated, including mortality, NSQIP-defined major morbidity, unplanned reoperation, and unplanned readmission. The association between case acuity and postoperative outcomes was assessed using multivariable logistic regression, adjusting for relevant patient and operative factors. A subgroup analysis was performed among non-elective repairs, comparing emergent cases to urgent cases.

Results/Outcomes: A total of 17,836 patients were identified, of whom 16,200 (90.8%) underwent an elective repair and 1,636 (9.2%) a non-elective repair. Patients who underwent a non-elective repair were more likely to be older (85 years-old: 29.5% vs. 13.9%, p< 0.001), of non-White race (23.2% vs. 18.3%, p< 0.001), functionally dependent (16.8% vs. 6.3%, p< 0.001), and more comorbid (American Society of Anesthesiologists score III/IV: 77.1% vs. 55.1%, p< 0.001). Perineal repairs were more common in the non-elective setting (59.7% vs. 40.7%, p< 0.001) and minimally invasive abdominal repairs were less common (18.6% vs. 39.8%, p< 0.001). Patients who underwent non-elective repairs had higher rates of 30-day postoperative mortality (3.7% vs. 0.7%, p< 0.001), major morbidity (20.5% vs. 9.6%, p< 0.001), unplanned reoperation (6.0% vs. 3.0%, p< 0.001), and readmission (12.7% vs. 6.6%, p< 0.001). They also had a significantly longer length of stay (median 6 days vs. 2 days, p< 0.001) and were more likely to be discharged to another facility (24.9% vs. 6.5%, p< 0.001). On regression analysis, non-elective repair was independently associated with increased odds of mortality (aOR: 2.97, 95% CI 2.10-4.14), major morbidity (aOR: 2.16, 95% CI 1.87-2.38), unplanned reoperation (aOR: 1.88, 95% CI 1.49-2.39) and readmission (aOR: 1.87, 95% CI 1.57-2.20). On subgroup analysis, as compared to urgent repairs, emergent repairs were associated with even higher rates of mortality (6.3% vs. 3.3%, p-0.022) and major morbidity (25.7% vs. 19.6%, p=0.030).

Conclusion/Discussion: In this multicenter cohort, nearly 10% of rectal prolapse repairs were performed in the non-elective setting. Non-elective repairs were more likely performed using a perineal approach and were associated with an increased risk for 30-day morbidity and mortality. The risk was incrementally higher for patients undergoing true emergent surgery for rectal prolapse. When appropriate, efforts should be made to defer rectal prolapse repair to the elective setting.