eP471 - Impact of Frailty on Postoperative Outcomes in Patients After Surgical Management for Rectal Prolapse

Purpose/Background: Rectal prolapse can lead to debilitating symptoms including fecal incontinence, urgency, constipation and outlet dysfunction. Perineal approaches have been associated with lower morbidity but higher recurrence rates, and are sometimes preferred for older patients or those with extensive comorbidities. Frailty index was studied in colorectal surgeries to determine the risk of postoperative morbidity and mortality. This study explores the effects of frailty on postoperative outcomes after surgical management for rectal prolapse.Methods/Interventions: This is a retrospective observational study on all patients who underwent rectal prolapse surgery at our institution between 9/1/2018-10/1/2022. The 11 factor modified frailty index (mFI-11) was used. Those with mFI-11 ≥ 0.2 were considered frail and the numeric mFI-11 was dichotomized into a binary response. Data on baseline characteristics, complications within 30 days of surgery, recurrences and functional outcomes were collected. Analyses including standard descriptive statistics, univariate comparison (Chi square analysis or fisher exact test for categorical variables and student's t-test for continuous variables) and multivariable regression models were performed using SPSS software.Results/Outcomes: 63 patients were included in the study. The mean age was 64 years, 88.9% were female and the mean BMI was 24.5 kg/m2. The most common type of surgery performed was robotic ventral mesh rectopexy at 57.1%. 14.3% had resection with suture rectopexy and 28.6% had Delorme/Altemeier procedure. The mean mFI-11 score was 0.09. 36.5% had mFI-11≥ 0.2 and were considered frail. The overall complication rate within 30 days was 20.6% and recurrence rate was 16.9%. The mean hospital length of stay was 2 days and the mean follow up was 47 weeks. 2 patients died within 30 days of discharge and 2 additional patients did not follow up. There was a statistically significant correlation between age, ASA, BMI, presentation of constipation with rectal prolapse, history of pelvic surgery, history of rectal prolapse recurrence, history of rectal prolapse surgery, rectal prolapse surgery type and frailty. There was also a weak but significant correlation between pelvic floor disorder and frailty. Frail patients also had significantly higher rates of urinary retention, infection, complications within 30 days of discharge and significantly higher rates of discharge to rehab facility compared to nonfrail patients. Despite these correlative differences, there were no differences in recurrence and functional outcomes between the frail and nonfrail patients. Multivariable analyses were performed with the factors identified in the univariable analysis. Frailty was not an independent risk factor for complications, recurrences or functional outcomes. However, abdominal approach was an independent predictor for fewer complications (P=0.042, OR 0.068, CI 0.005-0.904) and pelvic floor disorder was an independent predictor for improved functional outcome in constipation (p=0.042, OR 18.432, CI 1.105-307.38) and quality of life (p=0.041, OR 25.141, CI 1.145-552.203).Conclusion/

Discussion: Our data showed that mFI-11 cannot be used as an independent predictor for postoperative outcomes after rectal prolapse surgery. The heterogeneity of rectal prolapse surgery performed even at a single institution makes it challenging to study. Further research is needed to explore the impact on frailty in the rectal prolapse population.Baseline characteristics and outcomes in frail and nonfrail patients