Population-adjusted Rates of Rectal Prolapse Repair in Washington State Over a Contemporary, 12-year Time Period
Main Article Content
Abstract
Background: Rectal prolapse, with or without concurrent vaginal prolapse, is a debilitating condition. Despite debate regarding the optimal surgical approach, operative repair remains the mainstay of treatment. Our objective was to describe trends of rectal prolapse repair in Washington State.
Methods: A retrospective cohort of patients undergoing rectal prolapse repair was created from the Washington State Comprehensive Hospital Abstract Reporting System. Age- and sex-adjusted rates of rectal prolapse repair alone and concurrent rectal and vaginal prolapse repair, trends over time, and factors associated with variation in rates are described.
Results: There were 2755 hospitalizations in which patients underwent rectal prolapse repair, with 33.3% undergoing concurrent rectal and vaginal prolapse repair. Seventy-five percent of all repairs were in patients older than 50. Rates for rectal prolapse repair went from 3.72/100,000 people in 2008 to 3.25/100,000 people in 2019 (p=0.003) and did not increase in patients ages 65-79 (p=0.09) or older than 80 (p=0.945). Perineal repairs accounted for 31% of repairs and declined after 2014. Minimally-invasive abdominal repairs doubled from 32.5% in 2008 to 65.4% in 2019 (p<0.001). Seventy-five percent of patients lived within 20 miles of the treating facility.
Conclusions: Despite a broad shift towards abdominal, minimally invasive approaches, population-adjusted rates of rectal prolapse repair have remained stable in Washington State, even in elderly demographics in which rectal prolapse is more prevalent. Most patients receive operations at local facilities, but rates of repair vary with population size and number of surgeons, suggesting there are other factors driving care for rectal prolapse at a population level.
Keywords:
Rectal prolapse repair, pelvic organ prolapse, minimally invasive surgery
Article Details
How to Cite
SORIANO, Celine R. et al.
Population-adjusted Rates of Rectal Prolapse Repair in Washington State Over a Contemporary, 12-year Time Period.
Medical Research Archives, [S.l.], v. 12, n. 9, sep. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5741>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i9.5741.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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10. Perrenot C, Germain A, Scherrer ML, Ayav A, Brunaud L, Bresler L. Long-term outcomes of robot-assisted laparoscopic rectopexy for rectal prolapse. Dis Colon Rectum. 2013;56(7):909-914. doi:10.1097/DCR.0b013e318289366e
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14. Higgins EW, Yandell PM, Shull BL, Kuehl TJ, Papaconstantinou HT. Coexistent rectal and vaginal prolapse: Report of a case series of combined surgical repair utilizing a perineal approach. Int Urogynecol J Pelvic Floor Dysfunct [Internet]. 2009;20(3):S462–3. https://www.embase.com/records?subaction=viewrecord&rid=1&page=1&id=L70076782
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16. Catanzarite T, Klaristenfeld DD, Tomassi MJ, Zazueta-Damian G, Alperin M. Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse. Dis Colon Rectum. 2018;61(7):861-867. doi:10.1097/DCR.0000000000001023
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21. El-Dhuwaib Y, Pandyan A, Knowles CH. Epidemiological trends in surgery for rectal prolapse in England 2001-2012: an adult hospital population-based study. Colorectal Dis. 2020;22(10):1359-1366. doi:10.1111/codi.15094
22. Wijffels N, Cunningham C, Dixon A, Greenslade G, Lindsey I. Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete?. Colorectal Dis. 2011;13(5): 561-566. doi:10.1111/j.1463-1318.2010.02242.x
23. Gunner CK, Senapati A, Northover JM, Brown SR. Life after PROSPER. What do people do for external rectal prolapse?. Colorectal Dis. 2016; 18(8):811-814. doi:10.1111/codi.13255
24. Young MT, Jafari MD, Phelan MJ, et al. Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era?. Surg Endosc. 2015;29(3):607-613. doi:10.1007/s00464-014-3707-3
25. Clark CE 3rd, Jupiter DC, Thomas JS, Papaconstantinou HT. Rectal prolapse in the elderly: trends in surgical management and outcomes from the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg. 2012;215(5):709-714. doi:10.1016/j.jamcollsurg.2012.07.004
26. Lee SH, Lakhtaria P, Canedo J, Lee YS, Wexner SD. Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. Surg Endosc. 2011; 25(8):2699-2702. doi:10.1007/s00464-011-1632-2
27. McCoy AC, Gasevic E, Szlabick RE, Sahmoun AE, Sticca RP. Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents' case logs from 2000 to 2011. J Surg Educ. 2013;70(6):683-689. doi:10.1016/j.jsurg.2013.09.002
28. Unruh KR, Bastawrous AL, Bernier GV, et al. Evaluating the Regional Uptake of Minimally Invasive Colorectal Surgery: a Report from the Surgical Care Outcomes Assessment Program. J Gastrointest Surg. 2021;25(9):2387-2397. doi:10.1007/s11605-020-04875-1
29. van Zanten F, van der Schans EM, Consten ECJ, et al. Long-term Anatomical and Functional Results of Robot-Assisted Pelvic Floor Surgery for the Management of Multicompartment Prolapse: A Prospective Study. Dis Colon Rectum. 2020;63(9): 1293-1301. doi:10.1097/DCR.0000000000001696
30. Diaz A, Schoenbrunner A, Cloyd J, Pawlik TM. Geographic Distribution of Adult Inpatient Surgery Capability in the USA. J Gastrointest Surg. 2019;23(8):1652-1660. doi:10.1007/s11605-018-04078-9
31. Finlayson SR, Birkmeyer JD, Tosteson AN, Nease RF Jr. Patient preferences for location of care: implications for regionalization. Med Care. 1999;37(2):204-209. doi:10.1097/00005650-199902000-00010
32. Ellis RJ, Yuce TK, Hewitt DB, et al. National Evaluation of Patient Preferences in Selecting Hospitals and Health Care Providers. Med Care. 2020;58(10):867-873. doi:10.1097/MLR.0000000000001374
33. Xu Z, Aquina CT, Justiniano CF, et al. Centralizing Rectal Cancer Surgery: What Is the Impact of Travel on Patients?. Dis Colon Rectum. 2020;63(3):319-325. doi:10.1097/DCR.0000000000001581
34. Consten EC, van Iersel JJ, Verheijen PM, Broeders IA, Wolthuis AM, D'Hoore A. Long-term Outcome After Laparoscopic Ventral Mesh Rectopexy: An Observational Study of 919 Consecutive Patients. Ann Surg. 2015;262(5):742-748. doi:10.1097/SLA.0000000000001401
35. van Iersel JJ, Paulides TJ, Verheijen PM, Lumley JW, Broeders IA, Consten EC. Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse. World J Gastroenterol. 2016;22(21):4977-4987. doi:10.3748/wjg.v22.i21.4977
2. Bordeianou L, Paquette I, Johnson E, et al. Clinical Practice Guidelines for the Treatment of Rectal Prolapse. Dis Colon Rectum. 2017;60(11): 1121-1131. doi:10.1097/DCR.0000000000000889
3. Russell MM, Read TE, Roberts PL, et al. Complications after rectal prolapse surgery: does approach matter? Dis Colon Rectum. 2012;55(4): 450-458. doi:10.1097/DCR.0b013e31823f86b8
4. Senapati A, Gray RG, Middleton LJ, et al. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013; 15(7):858-868. doi:10.1111/codi.12177
5. Cirocco WC. In search of the optimal operation for rectal prolapse: the saga continues…. Tech Coloproctol. 2019;23(1):1-2. doi:10.1007/s10151-019-01937-8
6. Riansuwan W, Hull TL, Bast J, Hammel JP, Church JM. Comparison of perineal operations with abdominal operations for full-thickness rectal prolapse. World J Surg. 2010;34(5):1116-1122. doi:10.1007/s00268-010-0429-0
7. Alwahid M, Knight SR, Wadhawan H, Campbell KL, Ziyaie D, Koch SMP. Perineal rectosigmoidectomy for rectal prolapse-the preferred procedure for the unfit elderly patient?. 10 years experience from a UK tertiary centre. Tech Coloproctol. 2019;23(11): 1065-1072. doi:10.1007/s10151-019-02100-z
8. Kariv Y, Delaney CP, Casillas S, et al. Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study [published correction appears in Surg Endosc. 2006 Feb;20(2): 343]. Surg Endosc. 2006;20(1):35-42. doi:10.1007/s00464-005-3012-2
9. Byrne CM, Smith SR, Solomon MJ, Young JM, Eyers AA, Young CJ. Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse. Dis Colon Rectum. 2008;51(11):1597-1604.
doi:10.1007/s10350-008-9365-6
10. Perrenot C, Germain A, Scherrer ML, Ayav A, Brunaud L, Bresler L. Long-term outcomes of robot-assisted laparoscopic rectopexy for rectal prolapse. Dis Colon Rectum. 2013;56(7):909-914. doi:10.1097/DCR.0b013e318289366e
11. Dekel A, Rabinerson D, Rafael ZB, Kaplan B, Mislovaty B, Bayer Y. Concurrent genital and rectal prolapse: two pathologies--one joint operation. BJOG. 2000;107(1):125-129. doi:10.1111/j.1471-0528.2000.tb11589.x
12. Altman D, Zetterstrom J, Schultz I, et al. Pelvic organ prolapse and urinary incontinence in women with surgically managed rectal prolapse: a population-based case-control study. Dis Colon Rectum. 2006;49(1):28-35. doi:10.1007/s10350-005-0217-3
13. González-Argenté FX, Jain A, Nogueras JJ, Davila GW, Weiss EG, Wexner SD. Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence or rectal prolapse. Dis Colon Rectum. 2001;44(7):920-926. doi:10.1007/BF02235476
14. Higgins EW, Yandell PM, Shull BL, Kuehl TJ, Papaconstantinou HT. Coexistent rectal and vaginal prolapse: Report of a case series of combined surgical repair utilizing a perineal approach. Int Urogynecol J Pelvic Floor Dysfunct [Internet]. 2009;20(3):S462–3. https://www.embase.com/records?subaction=viewrecord&rid=1&page=1&id=L70076782
15. Geltzeiler CB, Birnbaum EH, Silviera ML, et al. Combined rectopexy and sacrocolpopexy is safe for correction of pelvic organ prolapse. Int J Colorectal Dis. 2018;33(10):1453-1459. doi:10.1007/s00384-018-3140-5
16. Catanzarite T, Klaristenfeld DD, Tomassi MJ, Zazueta-Damian G, Alperin M. Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse. Dis Colon Rectum. 2018;61(7):861-867. doi:10.1097/DCR.0000000000001023
17. Speed JM, Zhang CA, Gurland B, Enemchukwu E. Trends in the Diagnosis and Management of Combined Rectal and Vaginal Pelvic Organ Prolapse. Urology. 2021;150:188-193. doi:10.1016/j.urology.2020.05.010
18. Comprehensive Hospital Abstract Reporting System (CHARS): Washington State Department of Health. https://doh.wa.gov/dataandstatisticalreports/healthcareinwashington/hospitalandpatientdata/hospitaldischargedatachars. Accessed 18 Aug 2020
19. Washington Data & Research Population Estimates. https://www.ofm.wa.gov/washington-data-research/population-demographics/population-estimates/estimates-april-1-population-age-sex-race-and-hispanic-origin
20. Rogers AC, McCawley N, Hanly AM, Deasy J, McNamara DA, Burke JP. Trends in the treatment of rectal prolapse: a population analysis. Int J Colorectal Dis. 2018;33(4):459-465. doi:10.1007/s00384-018-2971-4
21. El-Dhuwaib Y, Pandyan A, Knowles CH. Epidemiological trends in surgery for rectal prolapse in England 2001-2012: an adult hospital population-based study. Colorectal Dis. 2020;22(10):1359-1366. doi:10.1111/codi.15094
22. Wijffels N, Cunningham C, Dixon A, Greenslade G, Lindsey I. Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete?. Colorectal Dis. 2011;13(5): 561-566. doi:10.1111/j.1463-1318.2010.02242.x
23. Gunner CK, Senapati A, Northover JM, Brown SR. Life after PROSPER. What do people do for external rectal prolapse?. Colorectal Dis. 2016; 18(8):811-814. doi:10.1111/codi.13255
24. Young MT, Jafari MD, Phelan MJ, et al. Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era?. Surg Endosc. 2015;29(3):607-613. doi:10.1007/s00464-014-3707-3
25. Clark CE 3rd, Jupiter DC, Thomas JS, Papaconstantinou HT. Rectal prolapse in the elderly: trends in surgical management and outcomes from the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg. 2012;215(5):709-714. doi:10.1016/j.jamcollsurg.2012.07.004
26. Lee SH, Lakhtaria P, Canedo J, Lee YS, Wexner SD. Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. Surg Endosc. 2011; 25(8):2699-2702. doi:10.1007/s00464-011-1632-2
27. McCoy AC, Gasevic E, Szlabick RE, Sahmoun AE, Sticca RP. Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents' case logs from 2000 to 2011. J Surg Educ. 2013;70(6):683-689. doi:10.1016/j.jsurg.2013.09.002
28. Unruh KR, Bastawrous AL, Bernier GV, et al. Evaluating the Regional Uptake of Minimally Invasive Colorectal Surgery: a Report from the Surgical Care Outcomes Assessment Program. J Gastrointest Surg. 2021;25(9):2387-2397. doi:10.1007/s11605-020-04875-1
29. van Zanten F, van der Schans EM, Consten ECJ, et al. Long-term Anatomical and Functional Results of Robot-Assisted Pelvic Floor Surgery for the Management of Multicompartment Prolapse: A Prospective Study. Dis Colon Rectum. 2020;63(9): 1293-1301. doi:10.1097/DCR.0000000000001696
30. Diaz A, Schoenbrunner A, Cloyd J, Pawlik TM. Geographic Distribution of Adult Inpatient Surgery Capability in the USA. J Gastrointest Surg. 2019;23(8):1652-1660. doi:10.1007/s11605-018-04078-9
31. Finlayson SR, Birkmeyer JD, Tosteson AN, Nease RF Jr. Patient preferences for location of care: implications for regionalization. Med Care. 1999;37(2):204-209. doi:10.1097/00005650-199902000-00010
32. Ellis RJ, Yuce TK, Hewitt DB, et al. National Evaluation of Patient Preferences in Selecting Hospitals and Health Care Providers. Med Care. 2020;58(10):867-873. doi:10.1097/MLR.0000000000001374
33. Xu Z, Aquina CT, Justiniano CF, et al. Centralizing Rectal Cancer Surgery: What Is the Impact of Travel on Patients?. Dis Colon Rectum. 2020;63(3):319-325. doi:10.1097/DCR.0000000000001581
34. Consten EC, van Iersel JJ, Verheijen PM, Broeders IA, Wolthuis AM, D'Hoore A. Long-term Outcome After Laparoscopic Ventral Mesh Rectopexy: An Observational Study of 919 Consecutive Patients. Ann Surg. 2015;262(5):742-748. doi:10.1097/SLA.0000000000001401
35. van Iersel JJ, Paulides TJ, Verheijen PM, Lumley JW, Broeders IA, Consten EC. Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse. World J Gastroenterol. 2016;22(21):4977-4987. doi:10.3748/wjg.v22.i21.4977