Risk factors for mortality and end-colostomy in patients with sigmoid volvulus managed by sigmoid resection

BACKGROUND: The traditional operative treatment of sigmoid volvulus is sigmoid resection. The risks involved in its timing are not clear. This study evaluates the impact of timing of surgery and demographic factors on surgical outcome and the risk of mortality and end colostomy in patients with sigmoid volvulus.METHODS: Medical records of 100 patients with sigmoid volvulus treated with sigmoid resection were studied retrospectively. Patients were divided into three groups. Group 1 (N.=48): emergency sigmoid resection, group 2 (N.=14): emergency endoscopic detorsion and planned sigmoid resection during same hospitalization, group3 (N=38): emergency endoscopic detorsion and readmission for elective sigmoid resection. Uni-and multivariate regression analyses were performed to assess the risk of end colostomy and mortality. RESULTS: There was no statistical difference in the duration of hospital stay, the risk of end colostomy or rate of reoperation between groups (P=0.140, P=0.062 and P=0.432 respectively). Regression analysis showed ASA-Classification >= 4 to associate with an increased risk of end colostomy (P=0.012). Thirty-day mortality was 4% and there was no difference between the groups (P=0.660). One year mortality varied significantly between the groups (P=0.008) and the regression analysis showed surgery in an emergency setting (group 1) and living at a nursing home (P=0.027 and P<0.001) to independently predict increased risk for 1-year mortality.CONCLUSIONS: Emergency surgery increases 1-year mortality after sigmoid resection for sigmoid volvulus. Frailty associates with both 1-year mortality and the risk for end colostomy. Elective surgery is preferred, but its timing does not affect surgical outcome or survival. ; Peer reviewed