EP919 - Comparison between Delorme and Altemeier procedures for rectal prolapse: a NSQIP analysis.

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Purpose/Background: Only small studies have compared Delorme versus Altemeier perineal procedures for rectal prolapse. We aim to evaluate their differences using a large patient sample utilizing the National Surgical Quality Improvement Program (NSQIP) database maintained by the American College of Surgeons (ACS).

Methods/Interventions: Data from January 2016 to December 2021 was extracted from the NSQIP database using the Current Procedural Terminology (CPT) codes for Altemeier (45130) and Delorme (45505) procedures. Patients younger than 50 years-old and those with incomplete data were excluded. The primary outcome was 30-day mortality and secondary outcomes were 30-day complications.

Results/Outcomes: A total of 4451 patients were included, with 3922 (88.1%) in the Altemeier group (AG) and 529 (11.9%) in the Delorme group (DG). Of those, 94% were female in the AG versus 73% in the DG (p < 0.001). The AG patients were older than DG, with the first having 49.8% greater than 80 years old versus 28.6% (p < 0.001). Median (IQR) BMI was 23.82 kg/m2 (20.8, 27.6) in the AG versus 26.1 kg/m2 (22.7, 30.2) in the DG (p < 0.001). Functional health prior to surgery was better in the DG with 94.5% of patients being independent versus 87.2% in the AG (p < 0.001). ASA classification favored the DG, with 44.8% of patients being Class II versus 26.8% in the AG, and 47.1% being Class III versus 64.5% in the AG (p < 0.001) – Table 1. Given the significant difference in baseline characteristics within the two groups, a propensity-match analysis for age and ASA class was performed with an AG:DG ratio of 2.7:1. The 30-day mortality was 1.3% in the AG versus 0% in the DG group (p < 0.001). Additionally, the AG had longer operative time, median (IQR) 75 (55, 101) minutes versus 59 (35, 86.3) minutes (p < 0.001); and longer length of hospital stay, median (IQR) 2.0 (1.0, 3.0) days versus 1.0 (0.0, 2.0) days (p < 0.001). The AG group also had higher rates of unplanned return to the operating room (6.0% versus 0.5%, p< 0.001), unplanned readmission (9.3% versus 1.8%, p=0.001), organ space surgical site infection (4.4% versus 0.1%, p< 0.001), pneumonia (1.3% versus 0.1%, p=0.003), unplanned intubation (0.6% versus 0.0%, p=0.024), sepsis (1.3% versus 0.2%, p=0.037), and septic shock (1.0% versus 0.0%, p=0.002). Outcomes were similar between the groups for superficial or deep SSI, wound disruption, urinary tract infections, acute renal failure, Clostridium difficile infection, deep vein thrombosis, pulmonary embolism, blood transfusions, stroke, myocardial infarction, and cardiac arrest – Table 2. Data regarding the preoperative size/severity of the rectal prolapse or postoperative recurrence rates were not available in the NSQIP database.

Conclusion/Discussion: Our results suggest that patients who underwent Delorme procedure have better perioperative outcomes when compared to those who had Altemeier procedure.