Getting to the bottom of treatment of rectal prolapse in the elderly: Analysis of the National Surgical Quality Improvement Program (NSQIP).
Am J Surg
; 218(2): 288-292, 2019 08.
Article
em En
| MEDLINE
| ID: mdl-30803700
ABSTRACT
BACKGROUND:
Many approaches to treat rectal prolapse exists, yet little is known regarding their safety in the elderly.METHOD:
NSQIP (2008-2014) was queried to identify patientsâ¯≥â¯70 years who underwent open rectopexy (OR), laparoscopic rectopexy (LR) and perineal rectosigmoidectomy (PR). Patients were selected using NSQIP's estimated probability of morbidity of ≥50th percentile. Outcomes were 30-day mortality and a composite mortality, septic shock and organ space abscess and fascial dehiscence.RESULTS:
Overall, 1361 patients underwent OR(18%), LR(15%) and PR(67%) with no difference in outcomes among 3 approaches. After adjustment of other factors, the composite was associated with PR [OR 2.5, CI 1.1, 5.7] and not with older age [OR 1.3, (CI) 0.7, 2.4]. From 2008 to 2014, LR increased from 11% to 19%; and PR decreased from 75% to 72%.CONCLUSIONS:
All 3 surgical approaches carry low morbidity among the sick, elderly. PR remains the predominant approach nationally. A paradigm shift accepting the safety of abdominal approaches is needed. There should also be less focus on age in the decision-making process of surgical treatment.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Prolapso Retal
/
Melhoria de Qualidade
Tipo de estudo:
Prognostic_studies
Limite:
Aged
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Aged80
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Female
/
Humans
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Male
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article