(124) Incidence and Complications of Rectopexy in the United Kingdom and United States, 2013-2022.

Background: Rectopexy is a surgery used to repair rectal prolapse. In the 2010s, concerns were raised about complications associated with the use of mesh in some pelvic surgeries, including rectopexy. This led to a major investigation in the UK – resulting in the landmark ‘Cumberlege report’, which found that “current data does not reflect true complication rates”, so studies are needed to better inform patients about the likely adverse events associated with surgery.

Objectives: 1. Determine the population incidence rate of rectopexy in the UK/US population from 01/01/2013 to 31/12/2022.
2. Study the incidence of complications, and re-operation, post-surgery.

Methods: We performed a retrospective cohort study, using 4 databases mapped to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) , which included 34,248,455 (CPRD Aurum), 2,643,160 (Barts Health), 17,054,819 (CPRD GOLD), and 34,808,145 people (Pharmetrics).

Participants aged ≥18yo between 2013 and 2021 were included. SNOMED codes were used to define rectopexy and rectal prolapse, and associated complications of pain, haemorrhage, constipation, obstruction, and re-operation.

In primary healthcare databases (CPRD GOLD and Aurum), the source population was used as a denominator for overall incidence rate and prevalence calculations. The proportion of prolapse patients being treated with rectopexy was calculated. For complications, the incidence rate was derived from the population who underwent rectopexy.

Results: Across the data sources, 8,283 patient records included rectopexy surgery. The mean age varied from 57 – 66 (sd 17), and the percentage of females was 75 – 91%.

Over the study period, the incidence rate of rectopexy decreased, from 4.96/100,000py - 7.16/100,000py in 2013, to 2.39/100,000 – 4.42/100,000 in 2021. The proportion of people with rectal prolapse who were treated with rectopexy decreased over the same period, from 13% - 25% in 2013, to 2% – 4% in 2021, and plateaued around 2019. From 2017 onwards, this proportion was similar across the UK data sources, but was at least double the UK proportion, in the US database, Pharmetrics.

Rates of complications were similar across the databases. In the UK hospital database, Barts Health, post-operative pain within 90 days occurred in 7.97%, constipation in 7.88%, obstruction in 1.74%, and post-operative bleeding in 0.67%. Re-operation rates in CPRD Aurum were 5.32% from days 31-90, 4.44% (days 91-365), and 2.58% (days 366-730).

Conclusions: The incidence rate of rectopexy is decreasing, as a smaller proportion of people with rectal prolapse receive surgery. Complication and re-operation rates are common post-surgery.