Association Between Frailty and Preoperative Decision-Making in Rectal Prolapse Repair

Area of Science:

• Colorectal surgery
• Surgical decision-making
• Patient frailty assessment

Background:

• Rectal prolapse repair approaches (abdominal vs. perineal) are based on surgeon risk assessment, which can be subjective.
• The preoperative Risk Analysis Index (RAI) is a validated measure of patient frailty.

Purpose of the Study:

• To evaluate the alignment between preoperative RAI scores and surgeon-determined operative approaches for rectal prolapse repair.
• To investigate if RAI can offer an objective measure to guide surgical decisions.

Main Methods:

• A registry of rectal prolapse repair cases (2017-2022) was reviewed.
• Preoperative RAI scores were collected, with a score ≥30 indicating significant frailty.
• Patient characteristics and outcomes were compared between abdominal and perineal repair groups.

Main Results:

• Perineal repair patients were significantly more likely to be frail (41% vs. 7%) and have cardiac comorbidities (69% vs. 32%) compared to abdominal repair patients.
• Higher recurrence rates were observed after perineal repair (39% vs. 9%).
• Many non-frail patients underwent perineal repair, suggesting potential surgeon bias in approach selection.

Conclusions:

• The RAI score can provide an objective measure of frailty to complement surgeon assessment in selecting the operative approach for rectal prolapse.
• Utilizing the RAI tool may help mitigate surgeon bias and optimize treatment decisions for rectal prolapse repair.