A. Easterday1, A. Person1, S. Aurit1, R. Driessen1, D. Mukkai Krishnamurty1 1Creighton University Medical Center,Department Of Surgery,Omaha, NE, USA
Introduction: Data on perioperative outcomes following surgery for sigmoid volvulus is limited. The aim of this study is to develop a model to predict need for emergent surgery and post-operative mortality following resection for sigmoid volvulus.
Methods: The NSQIP database was queried from 2012-2016 to identify patients undergoing segmental resection for sigmoid volvulus. Pre-, intra-, and post-operative variables were compared. Primary and secondary outcomes were emergent surgery and risk of mortality, respectively. Chi-square and Fischer’s test for categorical variables and the Mann-Whitney test for continuous variables were used. Significant variables for each outcome were entered into a logistic regression model to predict the outcomes. Statistical significance was set at p<0.05.
Results: A total of 2,086 patients met inclusion criteria and 51.6 percent underwent an elective resection. Median age was 68 years. Laparoscopic resection (30.5% vs. 9.1%; p<0.001) and mechanical bowel preparation (50% vs. 8.7%; p<0.001) were more commonly used in the elective setting. Patients having emergent resection were more likely to suffer from post-operative superficial surgical site infection (p<0.001), pneumonia (p<0.001), cardiac arrest (p=0.038), septic shock (p=0.001), myocardial infarction (p=0.034), and had a higher need for perioperative transfusion (p<0.001). No difference was seen in ileus, anastomotic leaks, readmission or re-operation rates in patients undergoing emergency vs. elective resection. Overall mortality rate was 6.2% (8.5% in the emergent group vs. 4.1% in the elective group; p<0.001). On multivariate analysis, factors associated with increased risk of emergency surgery included female gender (OR 2.01; p<0.001), relative hematocrit elevation (OR=1.058; p<0.001), relative leukocytosis (OR=1.172; p<0.001), acute kidney injury (OR=6.274; p=0.035), pre-operative sepsis (OR=2.037; p<0.001), functional independence prior to surgery (OR=1.525; p=0.011), and bleeding disorders (OR=1.592; p=0.020). Factors predictive of post-operative mortality included increased age (OR=1.064; p<0.001), systemic sepsis (OR=3.848; p<0.001), and emergent surgery (OR=2.086; p=0.007). Independence prior to illness (OR=0.371; p<0.001), higher albumin levels (OR=0.579; p=0.007), and lower BMI (OR=0.952; p=0.037) were shown to be protective.
Conclusion: Emergent resection for sigmoid volvulus is independently associated with poor post-operative outcomes and mortality. Pre-operative factors that predict need for emergent resection and post-operative mortality identified in this study can be used to aid in shared decision making and counselling for patients admitted with sigmoid volvulus.