Sigmoid volvulus: Evaluating identification strategies and contemporary multicenter outcomes

Area of Science:

• Gastroenterology
• Epidemiology
• Surgical Outcomes

Background:

• Limited epidemiologic data exists for sigmoid volvulus (SV) in non-endemic regions.
• Multicenter studies are needed to understand contemporary outcomes and diagnostic methods for SV.

Purpose of the Study:

• To report contemporary outcomes of sigmoid volvulus (SV) in a multicenter cohort.
• To evaluate literature-based methods for identifying SV using diagnostic and procedural codes.

Main Methods:

• A 10-year automated search identified patients with 'volvulus'.
• Electronic charts were reviewed to confirm SV diagnosis and assess 6-month outcomes.
• Three literature-based strategies for SV identification were replicated.

Main Results:

• Of 895 patients, 109 had confirmed SV; literature-based strategies showed poor accuracy.
• Treatment included endoscopic reduction alone (33%) or surgery (emergent, semi-elective, elective).
• Endoscopic reduction alone was associated with high recurrence rates; delayed surgery correlated with worse outcomes.

Conclusions:

• Literature-based coding strategies for SV are unreliable and introduce misclassification bias.
• A significant proportion of SV patients do not undergo surgery during their initial admission.
• Earlier surgical intervention in SV cases is associated with improved patient outcomes.