Despite the financial and value-based implications associated with higher levels of care at discharge, few studies have evaluated modifiable treatment factors that may optimize post-acute care. The aim was to assess the association between operative approach and disposition to a higher level of care and other outcomes following rectal prolapse surgery.
Using a retrospective cohort study design, the NSQIP database was used to identify patients between 2012-2017 with rectal prolapse who underwent perineal repair or open or laparoscopic rectopexy with or without resection. Discharge destination and 30-day postoperative outcomes were compared between propensity-matched groups. Nomograms generated using multivariable regression calculate the risk of requiring higher levels of care upon discharge and morbidity.
Propensity-matched analysis included 3,000 patients (1,500 in the perineal group, 580 in the open abdominal group, and 920 in the minimally invasive (MIS) group). Patients who received open abdominal surgery were more likely to require elevation of care at destination compared to those who received perineal surgery (OR 1.65, 95% CI 1.22-1.24) and MIS abdominal surgery (OR 1.80, 95% CI 1.18-2.76). Similar effects were seen for overall morbidity. Increased age, higher ASA class, congestive heart failure, overall morbidity, dependent functional status, and open surgery were independent predictors of discharge to higher level of care (c statistic=0.79).
Open surgery compared to MIS and perineal surgery was associated with higher levels of discharge disposition following rectal prolapse surgery. Future research should continue to identify modifiable treatment factors that reduce poor postoperative outcomes among rectal prolapse patients.

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