Population-adjusted Rates of Rectal Prolapse Repair in Washington State Over a Contemporary, 12-year Time Period

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 (RPR) alone and concurrent rectal and vaginal prolapse repair (CRVR), trends over time, and factors associated with variation in rates are described. Results There were 2755 hospitalizations in which patients underwent RPR, with 33.3% undergoing CRVR. 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.