Rectal Prolapse Repair Improves Bowel Symptoms in Women With Psychiatric Disorders: A Cohort Analysis of a Single-Center Registry.
Source: PubMed, NCBI / U.S. National Library of Medicine
Psychiatric disorders are prevalent in patients with rectal prolapse. Although psychiatric disorders are associated with poor surgical outcomes and worse health in general, it is unknown how they impact rectal prolapse repair. To determine rectal prolapse symptom severity in patients with psychiatric disorders and how surgical repair modified these symptoms. Retrospective analysis of a prospectively maintained database. Academic colorectal practice. Female patients with and without psychiatric comorbidities who underwent rectal prolapse repair with preoperative and 1-year postoperative Pelvic Floor Distress Inventory (PFDI-20) scores. One-year change in PFDI-20 score. Of 365 female patients in our registry, 146 met the inclusion criteria. Fifty-four patients (36%) had a psychiatric disorder. Depression (66%) and anxiety (44%) were the most prevalent conditions. Patients with a psychiatric disorder were significantly younger (median age [interquartile range]: 61 years [48-67] vs 70 years [60-77], p < 0.001) but otherwise had a similar prevalence of comorbidities such as cardiac disease. Preoperative symptom profile was similar, but patients with psychiatric disorders reported higher PFDI-20 scores reflecting greater prolapse-related distress (mean [SD]: 146 [70] vs 115 [55], p = 0.01). Postoperatively, PFDI-20 scores improved significantly in both groups (adjusted mean change from baseline for patients with rectal prolapse repair: psychiatric disorders: -88 [-130 to -47] vs no
Abstract
Psychiatric disorders are prevalent in patients with rectal prolapse. Although psychiatric disorders are associated with poor surgical outcomes and worse health in general, it is unknown how they impact rectal prolapse repair. To determine rectal prolapse symptom severity in patients with psychiatric disorders and how surgical repair modified these symptoms. Retrospective analysis of a prospectively maintained database. Academic colorectal practice. Female patients with and without psychiatric comorbidities who underwent rectal prolapse repair with preoperative and 1-year postoperative Pelvic Floor Distress Inventory (PFDI-20) scores. One-year change in PFDI-20 score. Of 365 female patients in our registry, 146 met the inclusion criteria. Fifty-four patients (36%) had a psychiatric disorder. Depression (66%) and anxiety (44%) were the most prevalent conditions. Patients with a psychiatric disorder were significantly younger (median age [interquartile range]: 61 years [48-67] vs 70 years [60-77], p < 0.001) but otherwise had a similar prevalence of comorbidities such as cardiac disease. Preoperative symptom profile was similar, but patients with psychiatric disorders reported higher PFDI-20 scores reflecting greater prolapse-related distress (mean [SD]: 146 [70] vs 115 [55], p = 0.01). Postoperatively, PFDI-20 scores improved significantly in both groups (adjusted mean change from baseline for patients with rectal prolapse repair: psychiatric disorders: -88 [-130 to -47] vs no psychiatric disorders: -44 [-68 to -19]). Models did not reveal a statistically significant differential improvement between groups, although patients with psychiatric disorders tended to have greater improvement in their scores compared to patients without psychiatric disorders. Single-center study with limited data on psychiatric comorbidity severity and disease control. Rectal prolapse patients with psychiatric disorders have prolapse-related distress at baseline but experience significant improvement after surgical repair, suggesting that appropriate management of rectal prolapse can improve their quality of life. The long-term durability of symptom improvement should be the focus of further work. See Video Abstract. ANTECEDENTES:Los trastornos psiquiátricos son frecuentes en pacientes con prolapso rectal. Si bien los trastornos psiquiátricos se asocian con malos resultados quirúrgicos y peor salud en general, se desconoce cómo afectan a la reparación del prolapso rectal.OBJETIVO:Determinar la gravedad de los síntomas del prolapso rectal en pacientes con trastornos psiquiátricos y cómo la reparación quirúrgica modificó estos síntomas.DISEÑO:Análisis retrospectivo de una base de datos mantenida de forma prospectiva.ENTORNO:Práctica académica colorrectal.PACIENTES:Pacientes mujeres con y sin comorbilidades psiquiátricas que se sometieron a una reparación de prolapso rectal con puntuaciones preoperatorias y postoperatorias al año en el Inventario de Distress del Suelo Pélvico (PFDI-20).MEDIDA DE RESULTADO PRINCIPAL:Cambio en la puntuación del PFDI-20 al cabo de un año.RESULTADOS:De las 365 pacientes de nuestro registro, 146 cumplían los criterios de inclusión. 54 (36 %) tenían un trastorno psiquiátrico. La depresión (66 %) y la ansiedad (44 %) fueron las afecciones más prevalentes. Las pacientes con un trastorno psiquiátrico eran significativamente más jóvenes (mediana [IQR] de edad: 61 [48, 67] frente a 70 [60,77], p < 0,001), pero por lo demás tenían una prevalencia similar de comorbilidades, como enfermedades cardíacas. El perfil de síntomas preoperatorios fue similar, pero los pacientes con trastornos psiquiátricos informaron puntuaciones PFDI-20 más altas, lo que refleja una mayor angustia relacionada con el prolapso (media [DE]: 146 [70] frente a 115 [55], p = 0,01). Después de la operación, las puntuaciones PFDI-20 mejoraron significativamente en ambos grupos (cambio medio ajustado con respecto al valor inicial para los pacientes con reparación de prolapso rectal: trastornos psiquiátricos: -88 [-130, -47] frente a sin trastornos psiquiátricos: -44 [-68, -19]). Los modelos no revelaron una mejora diferencial estadísticamente significativa entre los grupos, aunque los pacientes con trastornos psiquiátricos tendieron a presentar una mayor mejora en sus puntuaciones en comparación con los pacientes sin trastornos psiquiátricos.LIMITACIONES:Estudio de un solo centro con datos limitados sobre la gravedad de la comorbilidad psiquiátrica y el control de la enfermedad.CONCLUSIONES:Los pacientes con prolapso rectal y trastornos psiquiátricos sufren angustia relacionada con el prolapso en la línea de base, pero experimentan una mejora significativa después de la reparación quirúrgica, lo que sugiere que el tratamiento adecuado del prolapso rectal puede mejorar su calidad de vida. La durabilidad a largo plazo de la mejora de los síntomas debe ser el centro de atención de futuros trabajos. ( AI-generated translation ).