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BACKGROUND: The effect of age on short-term outcomes in patients undergoing surgical repair for full-thickness rectal prolapse is unknown.
METHODS: Using the National Surgical Quality Improvement Program (NSQIP) database (2005-2010) we selected a total of 1,876 patients with full-thickness rectal prolapse who underwent either perineal or abdominal repairs. Outcome variables included any or major postoperative complications (unplanned intubation, pulmonary embolism, acute renal failure, stroke, coma, cardiac arrest, myocardial infarction, sepsis/septic shock, bleeding requiring blood transfusion and death). Multivariate logistic regression models were used to describe the impact of age on outcomes.
RESULTS: A total of 909 patients (48.5%) underwent an abdominal procedure. Comorbid illness increased with age. Use of an abdominal approach decreased from 80.95% in the youngest patients (≤54 years) to 14.76% in the oldest patients (≥85 years, P<0.0001). When compared to patients younger than 54 years old, patients between 55-69 years were 51% less likely (OR=0.49, 95% CI 0.36-0.66), patients between 70-84 years were 87% less likely (OR=0.13, 95% CI 0.09-0.17) and patients older than 85 years were 95% less likely (OR=0.05, 95% CI 0.03-0.07) to have an abdominal procedure. Even in patients with no comorbidities (N=495) the use of an abdominal approach decreased with increasing age (83.78% to 10.42%, P<0.0001). When patients in the overall cohort were stratified by age (≤54y, 55-69y, 70-84y, and ≥85y), there were no differences within each strata with regards to overall or major complication rates between the two approaches. After adjusting for patient comorbidities and surgical approach, no differences in overall complications or major complications were observed across age groups. (Table 1)
CONCLUSIONS: With older age, fewer people with full-thickness rectal prolapse undergo abdominal surgical repair, even after controlling for baseline condition. Our data suggest that in carefully selected older patients, an abdominal approach to repair a rectal prolapse can be safely used.

Table 1. Effect of age on postoperative complications. Bivariate and Multivariate analysis

AGE GROUPS	ANY COMPLICATION				MAJOR COMPLICATIONS
	UNADJUSTED MODEL		ADJUSTED MODEL*		UNADJUSTED MODEL		ADJUSTED MODEL#
	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
≤54 years	Reference group				Reference group
55-69 years	1.04	0.69-1.57	0.91	0.60 - 1.39	1.87	0.86-4.06	1.33	0.62 - 3.07
70-84 years	1.13	0.77-1.67	0.95	0.61 - 1.48	3.11	1.52-6.35	2.05	0.94 - 4.48
≥85 years	0.88	0.57-1.37	0.71	0.42 - 1.19	2.55	1.18-5.48	1.60	0.68 - 3.78

*Adjusted to surgical approach, ASA class and dyspnea. ^#Adjusted to surgical approach, ASA class, cardiac comorbidities and chronic obstructive pulmonary disease