Survival outcomes in patients with sigmoid volvulus

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Geriatric Medicine

Background:

• Sigmoid volvulus (SV) disproportionately affects the elderly, presenting significant management challenges.
• High rates of re-admission and prolonged hospital stays are common with non-operative management of SV.
• Understanding outcomes is crucial for optimizing care in this vulnerable population.

Purpose of the Study:

• To evaluate management strategies and patient outcomes for sigmoid volvulus (SV) in an elderly cohort.
• To compare the effectiveness of surgical versus non-operative approaches in SV management.
• To identify factors influencing survival in elderly patients with SV.

Main Methods:

• Retrospective review of patients admitted with SV between 2019-2023.
• Collection of demographic, management, and outcome data, including frailty, ASA, and NELA scores.
• Comparative statistical analysis to assess factors associated with survival and management outcomes.

Main Results:

• 72 elderly patients (median age 78) were analyzed; 25 underwent surgery.
• Non-operative management led to re-admission in 88% of patients, with substantial hospital resource utilization.
• Surgical intervention was associated with a trend towards better survival, though mortality in non-surgical, non-palliated patients was 42%.

Conclusions:

• Sigmoid volvulus imposes a significant burden on the elderly, with high morbidity and mortality.
• While surgery shows better survival in selected cases, it's not universally applicable due to frailty and comorbidities.
• An individualized approach balancing risks and benefits is essential for managing SV in the elderly.