Preliminary Report from the Pelvic Floor Disorders Consortium: Large Scale Data Collection through Quality Improvement Initiatives to Provide Data on Functional Outcomes Following Rectal Prolapse Repair
Background: The surgical management of rectal prolapse is constantly evolving, yet numerous clinical trials and meta-analyses studying operative approaches have failed to make meaningful conclusions.
Objective: To report on preliminary data captured during a large-scale quality improvement initiative to measure and improve function in patients undergoing rectal prolapse repair.
Design: Retrospective analysis of prospectively collected surgical quality improvement data. Settings: This study was conducted at 14 tertiary centers specializing in pelvic floor disorders from 2017 to 2019.
Patients: A total of 181 consecutive patients undergoing external rectal prolapse repair.
Main outcome measures: Preoperative and three-month postoperative Wexner Incontinence Score and Altomare Obstructed Defecation Score.
Results: The cohort included 112 patients undergoing abdominal surgery 71 suture rectopexy /56% MIS, 41 ventral rectopexy/93% MIS). Those offered perineal approaches (N=68) were older (median age 75 vs 62, p<0.01) and had more comorbidities (ASA3-4: 51% vs. 24%, p<0.01), but also reported higher pre-intervention rates of fecal incontinence (Wexner 11.4 ± 6.4 vs. 8.6+/-5.8, p<0.01). Patients undergoing perineal procedures had similar incremental improvements in function after surgery as patients undergoing abdominal repair (change in Wexner -2.6 ± 6.4 vs. -3.1 ± 5.6, p= 0.6; change in Altomare -2.9 ± 4.6 vs. -2.7 ± 4.9, p=0.8). Similarly, posterior suture rectopexy and ventral mesh rectopexy patients had similar incremental improvements in overall scores; however, ventral mesh rectopexy patients had a higher decrease in the need to use pads after surgery.
Limitations: Retrospective data analysis and three-month follow up.
Conclusions: Functional outcomes improved in all patients undergoing prolapse surgery. Larger cohorts are necessary to show superiority amongst surgical procedures. Quality improvement methods may allow for systematic, yet practical acquisition of information and data analysis. We call for the creation of a robust database to benefit this patient population. See Video Abstract at http://links.lww.com/DCR/B581 .
Cavallaro PM, Vogler SA, Hyman NH, Ky AJ, Savitt LR, Tyler KM, Gurland BH, Bordeianou L; New England Society of Colorectal Surgery and the Pelvic Floor Disorders Consortium Rectal Prolapse Quality Incentive Workgroup Participants. Preliminary Report from the Pelvic Floor Disorders Consortium: Large Scale Data Collection through Quality Improvement Initiatives to Provide Data on Functional Outcomes Following Rectal Prolapse Repair. Dis Colon Rectum. 2021 Apr 26. doi: 10.1097/DCR.0000000000001962. Epub ahead of print.