American journal of surgery · 2024
Patience is key: Association of surgical timing with clinical outcomes in elderly patients with sigmoid volvulus.
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Arnold Suzanne C, Rafaqat Wardah, Abiad May, Lagazzi Emanuele, Hoekman Anne H, Panossian Vahe S, Nzenwa Ikemsinachi C, Paranjape Charudutt N, Velmahos George C, Kaafarani Haytham M A, Hwabejire John O
Аннотация
BACKGROUND: Current guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (>2 days) sigmoid colectomy.
METHODS: 2016-2019 NRD database was queried to identify patients aged ≥65 years admitted for sigmoid volvulus who underwent sequential endoscopic decompression and sigmoid colectomy. Outcomes included mortality, complications, hospital length of stay, readmissions, and hospital costs.
RESULTS: 842 patients were included, of which 409 (48.6 %) underwent delayed sigmoid colectomy. Delayed sigmoid colectomy was associated with reduced cardiac complications (1.1 % vs 0.0 %, p = 0.045), reduced ostomy rate (38.3 % vs 29.4 %, p = 0.013), an increased overall length of stay (12 days vs 8 days, p < 0.001) and increased overall costs (27,764 dollar vs. 24,472 dollar, p < 0.001).
CONCLUSION: In geriatric patient with sigmoid volvulus, delayed surgical resection after decompression is associated with reduced cardiac complications and reduced ostomy rate, while increasing overall hospital length of stay and costs.
METHODS: 2016-2019 NRD database was queried to identify patients aged ≥65 years admitted for sigmoid volvulus who underwent sequential endoscopic decompression and sigmoid colectomy. Outcomes included mortality, complications, hospital length of stay, readmissions, and hospital costs.
RESULTS: 842 patients were included, of which 409 (48.6 %) underwent delayed sigmoid colectomy. Delayed sigmoid colectomy was associated with reduced cardiac complications (1.1 % vs 0.0 %, p = 0.045), reduced ostomy rate (38.3 % vs 29.4 %, p = 0.013), an increased overall length of stay (12 days vs 8 days, p < 0.001) and increased overall costs (27,764 dollar vs. 24,472 dollar, p < 0.001).
CONCLUSION: In geriatric patient with sigmoid volvulus, delayed surgical resection after decompression is associated with reduced cardiac complications and reduced ostomy rate, while increasing overall hospital length of stay and costs.