Perioperative Outcomes and Predictors of Mortality After Surgery for Sigmoid Volvulus

Easterday, Anthony; Aurit, Sarah; Driessen, Rebecca; Person, Austin; Krishnamurty, Devi Mukkai

doi:10.1016/j.jss.2019.07.038

Cited by 21 publications

(9 citation statements)

References 30 publications

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“…3 Surgical management of patients by operation type presentation when compared to their index presentation, including the one mortality in the emergency surgery group. Given the well-established inverse relationship between ASA and outcome at emergency laparotomy, this finding further supports definitive management at the time of initial presentation [17,18]. Nonetheless, when taking into account the broadly comparable ASA figures across the operative and non-operative groups (see Table 2), we argue that outcomes remain optimal for those treated with definitive surgery irrespective of ASA.…”

Section: Discussionsupporting

confidence: 63%

Sigmoid volvulus: definitive surgery is safe and should be considered in all instances

et al. 2021

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Background Acute sigmoid volvulus (ASV) represents a small but significant portion of cases of large bowel obstruction, especially in the elderly and co-morbid. Given the characteristics of the patient cohort most commonly affected, a non-operative/conservative approach is often undertaken but is associated with a high rate of recurrence. Objective We sought to evaluate outcomes for those patients who underwent non-operative management, emergency surgery or staged, semi-elective surgery following decompression for ASV at our institution. Methods Hospital in-patient enquiry (HIPE) data were used to identify all patients who presented with sigmoid volvulus between January 2005 and June 2020 inclusive. Patient notes were interrogated, including surgical and endoscopic procedures performed. Patient demographics and co-morbidities were recorded. Results Thirty-nine patients were treated over a 15-year period with a mean age of 73 years at first presentation (range 36–93). Twenty-two patients (56%) had just a single admission for ASV with three deaths in this group. Seventeen patients (44%) had more than one admission with volvulus due to recurrence after a decompression-only strategy on the index admission. Of these, three succumbed to complications of their subsequent episodes of volvulus. Twenty-five patients underwent surgical intervention (fifteen on, or shortly following, their first admission and ten following at least two admissions for ASV). The overall mortality in the operative group was 2/25 (8%) with both deaths in those undergoing emergency surgeries. Five patients were treated successfully with endoscopic measures alone and had required no further interventions at the time of compiling data. Conclusion There is a high recurrence rate following non-operative management of acute sigmoid volvulus and consequently, a cumulative increase in the attendant significant morbidity and mortality with subsequent episodes. Given the relatively low complication rate of definitive surgery, even in those patients perceived to be high risk, we contend that all patients should be considered for early surgery to prevent the likely recurrence of sigmoid volvulus.

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Section: Discussionsupporting

confidence: 63%

Sigmoid volvulus: definitive surgery is safe and should be considered in all instances

et al. 2021

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“…Respiratory complications were the most common medical sequelae. Likewise, in other studies, medical morbidity included mainly cardiac and respiratory complications [ 2 , 20 , 21 ]. Concerning surgical complications, ileus (8.2%) and anastomotic leakage (6.1%) were the most frequent complications.…”

Section: Discussionmentioning

confidence: 99%

Sigmoid volvulus: outcomes of treatment and predictors of morbidity and mortality

Moro‐Valdezate

Martín-Arévalo

Plá-Martí

et al. 2022

Langenbecks Arch Surg

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Purpose To analyze the treatment outcomes for sigmoid volvulus (SV) and identify risk factors of complications and mortality. Methods Observational study of all consecutive adult patients diagnosed with SV who were admitted from January 2000 to December 2020 in a tertiary university institution for conservative management, urgent or elective surgery. Primary outcomes were 30-day postoperative morbidity, mortality and 2-year overall survival (OS), including analysis of risk factors for postoperative morbidity or mortality and prognostic factors for 2-year OS. Results A total of 92 patients were included. Conservative management was performed in 43 cases (46.7%), 27 patients (29.4%) underwent emergent surgery and 22 (23.9%) were scheduled for elective surgery. Successful decompression was achieved in 87.8% of cases, but the recurrence rate was 47.2%. Mortality rates following episodes were higher for conservative treatment than for urgent or elective surgery (37.2%, 22.2%, 9.1%, respectively; p = 0.044). ASA score > III was an independent risk factor for complications (OR = 5.570, 95% CI = 1.740–17.829, p < 0.001) and mortality (OR = 6.139, 95% CI = 2.629–14.335, p < 0.001) in the 30 days after admission. Patients who underwent elective surgery showed higher 2-year OS than those with conservative treatment (p = 0.011). Elective surgery (HR = 2.604, 95% CI = 1.185–5.714, p = 0.017) and ASA score > III (HR = 0.351, 95% CI = 0.192–0.641, p = 0.001) were independent prognostic factors for 2-year OS. Conclusion Successful endoscopic decompression can be achieved in most SV patients, but with the drawbacks of high recurrence, morbidity and mortality rates. Concurrent severe comorbidities and conservative treatment were independent prognostic factors for morbidity and survival in SV.

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“…Так, данный показатель статистически значимо был выше у умерших пациентов, особенно когда причиной летального исхода была тромбоэмболия легочной артерии (p = 0,014). Как и другие авторы [21], мы полагаем, что не стоит определять вероятность послеоперационного исхода только по лабораторным показателям, таким как показатель лейкоцитоза и уровень креатинина в предоперационном периоде.…”

Section: Discussionunclassified

Assessing the risk of postoperative mortality in patients undergoing emergency surgery for complicated colorectal cancer

Щаева

Магидов

2021

Onkol. koloproktol.

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Objective: to analyze factors affecting the mortality of patients who have undergone emergency surgeries for complicated colorectal cancer.Materials and methods. In this retrospective study, we evaluated treatment outcomes of 112 patients who underwent surgeries for complicated colorectal cancer in 3 clinical hospitals of Smolensk between 2014 and 2019. We included patients with moderate or severe disease (ASA II or III) who have undergone emergency resections for intestinal obstruction or tumor perforation. We assessed clinical, laboratory, and tumor‑associated factors affecting postoperative mortality.Results. Patients’ gender had no significant impact on postoperative mortality (p = 0.69). Mean age of study participants was 65 years (range: 43–86 years). Age also did not affect postoperative mortality; most of the patients both among those died (n = 19) and survived (n = 93) were older than 60 years (p = 0.46). We observed no significant correlation between tumor location and postoperative mortality (p = 0.27). Of 19 patients with lethal outcomes, five died due to pulmonary embolism. They have elevated level of D‑dimer, which was significantly higher than that in survivors (p = 0.014). The lowest mortality was observed in patients who have undergone two‑stage surgeries with tumor removed at the second stage compared to patients operated on using other techniques (p = 0.041). Using multivariate logistic regression, we identified independent factors that affected mortality. They included: tumor perforation (odds ratio (OR) 2.8; 95 % confidence interval (CI) 1.2–7.6; p = 0.003), severe comorbidity (OR 1.6; 95 % CI 1.7–8.2; p = 0.02), D‑dimer level >510.1 ± 10.2 ng/L (OR 1.5; 95 % CI 1.3–4.5; p = 0.01), type of surgery, namely resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage (OR 1.2; 95 % CI 1.1–6.3; p = 0.04).Conclusions. Tumor perforation, cardiovascular disease in combination with other comorbidities, type of surgery (resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage), and elevated preoperative level of D‑dimer had the most significant impact on postoperative mortality.

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Perioperative Outcomes and Predictors of Mortality After Surgery for Sigmoid Volvulus

Cited by 21 publications

References 30 publications

Sigmoid volvulus: definitive surgery is safe and should be considered in all instances

Sigmoid volvulus: definitive surgery is safe and should be considered in all instances

Sigmoid volvulus: outcomes of treatment and predictors of morbidity and mortality

Assessing the risk of postoperative mortality in patients undergoing emergency surgery for complicated colorectal cancer

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