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Sigmoid Volvulus Treatment Pattern Rates and Outcomes: A National Readmission Database Study

2022; Lippincott Williams & Wilkins; Volume: 235; Issue: 5 Linguagem: Inglês

10.1097/01.xcs.0000893336.62412.6e

1879-1190

Ryan Lamm, Arturo Rios Diaz, Hamza Rshaidat, Francesco Palazzo, Caitlyn Costanzo,

Clinical Nutrition and Gastroenterology

INTRODUCTION: Guidelines for treating sigmoid volvulus recommend endoscopic decompression and same admission sigmoidectomy to avoid recurrence. However, these guidelines have been largely based on retrospective and/or single institution studies. The objective of this study is to compare national rate of operative management (OM) with colonic resection vs nonoperative management (NOM) for sigmoid volvulus, as well as to compare the associated morbidity with each strategy. METHODS: Between 2010 and 2015 adult patients (≥18 years) admitted with a primary diagnosis of acute sigmoid volvulus were identified in the National Readmission Database (NRD). Patients were split into OM and NOM cohorts. Primary outcome was 1-year recurrence and secondary outcomes included overall mortality and 1-year readmission. Cox proportional hazard regression and logistic regression models were used to compare NOM vs OM outcomes. RESULTS: A total of 3,111 patients were admitted for acute sigmoid volvulus and underwent decompression via sigmoidoscopy. Of these, 1,878 (60%) received OM, while 1,233 (40%) received NOM during the same admission. NOM was associated with significantly higher 1-year recurrence (32% v 0.8%; hazard ratio [HR] 32.9 [9.2 - 118], p < 0.01) (Figure), 1-year readmission (57% v 41%; HR 1.6 [1.3 - 2], p < 0.01), and 1-year mortality (8% v 2%; HR 3.2 [1.7 - 6.3], p < 0.01) as well as higher mortality during the index admission (7% v 6%; odds ratio 2.1 [1.2 - 3.6], p < 0.01). CONCLUSION: Our study confirms that NOM for sigmoid volvulus exposes patients to significantly higher risk of recurrence, readmission, and mortality as compared with OM, although recurrence may not be as high as the historically quoted 80%.