Epidemiological trends in surgery for rectal prolapse in England 2001-2012: An adult hospital population-based study.

BACKGROUND: This study analysed trends in admission and surgery for rectal prolapse in adults in England between 2001 and 2012 as well as prolapse reoperation rates.

METHODS: Analysis of data derived from a comparative longitudinal population-based cohort study using Hospital Episode Statistics (HES).

RESULTS: During the study period, a total of 25,238 adults underwent a total of 29,379 operations for rectal prolapse (mean 2,662 per annum) [median age 73 years (IQE 58-83) years; female to male ratio: 7:1]. Median length-of-stay was 3 days (IQR 1-7) with an overall in-hospital mortality rate of 0.9%. Total number of admissions (2001: 4,950 vs. 2012: 8,927) and of patients undergoing prolapse surgery (2001: 2,230 vs. 2012: 2,808) significantly increased over the study period (P < 0.001 for trends). The overall increase in prolapse surgery (up by 1/3rd overall and 44% for elective) was dwarfed by an increase in popularity of laparoscopic surgery (increasing 15-fold). Overall prolapse reoperation rate was 12.7%. The lowest recurrence rate was observed for elective open resection (9.1%) but this had the highest mortality (1.9%). Laparoscopic and perineal fixations were also associated with low reoperation rates (<11%) but lower mortality rates, in the order of 0.3% for elective surgery. These data refute a trend toward subspecialisation (by surgeon or hospital) during the study period.

CONCLUSIONS: Admissions for rectal prolapse increased in England between 2001-2012 together with increases in surgery. Surgical decision making has changed over the period and may be reflected in outcome.