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Session: ePoster: Pelvic Floor 2 (Mon115)

EP806 - A PROPOSAL OF A NOVEL “SUPERSCORE” STATISTICALLY DERIVED FROM DIFFERENT VALIDATED PATIENT REPORTED OUTCOME MEASURES FOR DEFECATION DISORDERS

Monday, May 12, 2025
1:25 PM – 1:30 PM PT

    ePoster Presenter(s)

  • Carlo Ratto, MD, Hon Int F.A.S.C.R.S.

    M.D., Hon Int F.A.S.C.R.S.
    Isola Tiberina - Gemelli Isola Hospital
    Catholic University, Rome, Italy
    Rome, Lazio, Italy

    Disclosure information not submitted.

    • Author(s)

  • Angelo A. Marra, MD, PhD (he/him/his)

    General Surgeon
    Isola Tiberina - Gemelli Isola Hospital
    Rome, Lazio, Italy

    Disclosure information not submitted.

    • Author(s)

  • IS

    Ilaria Simonelli, n/a

    Statistician
    Isola Tiberina - Gemelli Isola Hospital
    Rome, Lazio, Italy

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Angelo A. Marra, MD, PhD: This individual has no financial relationships with ineligible companies.
Carlo Ratto, M.D., Hon Int F.A.S.C.R.S.: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Patient Reported Outcome Measures (PROMs) are an interesting tool to measure constipation and fecal incontinence severity. However, there are too many different PROMs investigating redundant and repetitive items. The aim of this study was to compare all items of the most used PROMs for Defecation Disorders (DD), including both constipation and fecal incontinence, to create a new “all-in-one” score (the “DD superscore”).

Methods/Interventions: This is a prospective observational study conducted at a tertiary academic center on consecutive patients who underwent robotic-assisted ventral mesh rectopexy for rectal prolapse from November 2020 to September 2024. Preoperatively, each patient was asked to complete six different validated PROMs: four questionnaires for constipation/obstructed defecation (Altomare score, ODS score, Cleveland Clinic Constipation Scoring System, PAC-SYM), one questionnaire for both constipation and fecal incontinence (Symptom Severity Score), and one questionnaire for fecal incontinence (Cleveland Clinic Fecal Incontinence Score).
A correlation and Exploratory Factor Analysis (EFA) was conducted to compare all items of the six PROMs and reconsider unnecessary ones. The assumptions of EFA were checked by Bartlett’s test of sphericity and the Kaiser-Meyer-Olkin Measure of Sampling Adequacy.

Results/Outcomes: Ninety-six patients were enrolled and completed all PROMs. In total, 50 items were analyzed. Firstly, all items were arranged in 18 items groups based on their similar content, as described in Figure 1. After EFA, it was possible to reconsider and exclude items of each PROMs that did not show a statistical correlation to the other components grouped by similar content, sometimes also for the way in which that specific symptom was measured. In particular, frequency of bowel movements described in daily or weekly attempts, stool consistency simplified into hard, small and few stools, use of laxatives as a dichotomic question, use of enema expressed in percentages, bleeding, rectal pain during or after defecation were reconsidered. The remaining ones were arranged in a novel “DD superscore”, that could be considered a proposal for a comprehensive, ideal PROMs for DDs, including both constipation and fecal incontinence.

Conclusion/Discussion: Our study demonstrates that a reduction in the number of items of several PROMs for constipation and fecal incontinence is promising. At this preliminary step of the study, the grouping of items based on similar contents allowed us to approach more rationally the large variety of questions that actually crowd the available PROMs. The following step will provide a further selection and analysis of the extrapolated items through a valid statistical method (like a Delphi consensus between experts) in order to share and validate the novel “DD superscore” in future trials.
Limitations of the study are: single-center pilot study, patients who underwent surgery for rectal prolapse; PROMs selection.