Comparative analysis of short-term outcomes after semielective and elective surgery for sigmoid volvulus.

Journal

Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347

Informations de publication

Date de publication:
26 Aug 2024
Historique:
received: 27 03 2024
revised: 11 06 2024
accepted: 28 07 2024
medline: 28 8 2024
pubmed: 28 8 2024
entrez: 27 8 2024
Statut: aheadofprint

Résumé

Data to guide surgical timing after colonic decompression for sigmoid volvulus are limited. Thus, we compared the postoperative outcomes of patients with sigmoid volvulus who underwent semielective (during index hospitalization after decompression) and elective surgery (subsequent elective hospitalization). We performed a retrospective review of 100% Medicare Provider Analysis and Review Files from 2016 to 2019, including Medicare beneficiaries aged ≥65 years who were urgently/emergently admitted for their index episode of volvulus and underwent colonic decompression followed by surgery. The mean age of 2,053 patients was 78 (standard deviation 8 years); 7% had elective surgery and 93% had semielective surgery (including 12.5% on the same day as decompression). In a bivariate analysis, elective surgery was associated with greater rates of minimally invasive surgery (32.8% vs 12.6%, P < .001), lower rates of ostomy formation (2.9% vs 36.0%, P < .001), and greater rates of discharge home (89.8% vs 47.4%, P < .001) with similar cumulative length of stay (8 vs 9 days, not significant) compared with semielective surgery. In a multivariable logistic regression, elective surgery was associated with reduced odds of morbidity (odds ratio, 0.60; 95% confidence interval, 0.49-0.74) and similar odds of mortality (odds ratio, 0.79; 95% confidence interval, 0.50-1.25) compared with semielective surgery, which remained consistent after excluding patients with surgery on the same day as decompression. After colonic decompression for sigmoid volvulus, elective surgery appears safe and is associated with favorable outcomes compared with semielective surgery. With the potential severe consequences of volvulus recurrence, these findings underscore the need for algorithms to predict recurrence risk to help guide careful patient selection for elective surgery.

Sections du résumé

BACKGROUND BACKGROUND
Data to guide surgical timing after colonic decompression for sigmoid volvulus are limited. Thus, we compared the postoperative outcomes of patients with sigmoid volvulus who underwent semielective (during index hospitalization after decompression) and elective surgery (subsequent elective hospitalization).
METHODS METHODS
We performed a retrospective review of 100% Medicare Provider Analysis and Review Files from 2016 to 2019, including Medicare beneficiaries aged ≥65 years who were urgently/emergently admitted for their index episode of volvulus and underwent colonic decompression followed by surgery.
RESULTS RESULTS
The mean age of 2,053 patients was 78 (standard deviation 8 years); 7% had elective surgery and 93% had semielective surgery (including 12.5% on the same day as decompression). In a bivariate analysis, elective surgery was associated with greater rates of minimally invasive surgery (32.8% vs 12.6%, P < .001), lower rates of ostomy formation (2.9% vs 36.0%, P < .001), and greater rates of discharge home (89.8% vs 47.4%, P < .001) with similar cumulative length of stay (8 vs 9 days, not significant) compared with semielective surgery. In a multivariable logistic regression, elective surgery was associated with reduced odds of morbidity (odds ratio, 0.60; 95% confidence interval, 0.49-0.74) and similar odds of mortality (odds ratio, 0.79; 95% confidence interval, 0.50-1.25) compared with semielective surgery, which remained consistent after excluding patients with surgery on the same day as decompression.
CONCLUSIONS CONCLUSIONS
After colonic decompression for sigmoid volvulus, elective surgery appears safe and is associated with favorable outcomes compared with semielective surgery. With the potential severe consequences of volvulus recurrence, these findings underscore the need for algorithms to predict recurrence risk to help guide careful patient selection for elective surgery.

Identifiants

DOI: 10.1016/j.surg.2024.07.041 PMID: 39191602
pubmed: 39191602
pii: S0039-6060(24)00560-9
doi: 10.1016/j.surg.2024.07.041
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Elsevier Inc. All rights reserved.

Auteurs

Bailey Hilty Chu (B)

Department of Surgery, Surgical Health Outcomes and Reaching for Equity (SHORE), University of Rochester Medical Center, NY. Electronic address: bailey_hiltychu@urmc.rochester.edu.

Anthony Loria (A)

Department of Surgery, Surgical Health Outcomes and Reaching for Equity (SHORE), University of Rochester Medical Center, NY. Electronic address: https://twitter.com/apl2018.

Xueya Cai (X)

Department of Biostatistics and Computational Biology, University of Rochester, NY.

Shan Gao (S)

Department of Biostatistics and Computational Biology, University of Rochester, NY.

Totadri Dhimal (T)

Department of Surgery, Surgical Health Outcomes and Reaching for Equity (SHORE), University of Rochester Medical Center, NY. Electronic address: https://twitter.com/TotadriD.

Yue Li (Y)

Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, NY. Electronic address: https://twitter.com/HSRYueli.

Paula Cupertino (P)

Department of Surgery, Surgical Health Outcomes and Reaching for Equity (SHORE), University of Rochester Medical Center, NY. Electronic address: https://twitter.com/APCupertino.

Larissa K Temple (LK)

Department of Surgery, Surgical Health Outcomes and Reaching for Equity (SHORE), University of Rochester Medical Center, NY.

Fergal J Fleming (FJ)

Department of Surgery, Surgical Health Outcomes and Reaching for Equity (SHORE), University of Rochester Medical Center, NY. Electronic address: https://twitter.com/FergaljFleming.

Classifications MeSH