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Sigmoid volvulus: Evaluating identification strategies and contemporary multicenter outcomes

  • Anthony Loria
    Correspondence
    Corresponding author. Surgical Health Outcomes & Research Enterprise (SHORE), The University of Rochester Medical Center, Saunders Research Building, Suite 124003, 265 Crittenden Blvd, Rochester, NY 14642, USA.
    Affiliations
    Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA

    Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
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  • Tricia Jacobson
    Affiliations
    Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
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  • Alexa D. Melucci
    Affiliations
    Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA

    Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
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  • Nicholas Bartell
    Affiliations
    Department of Medicine, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY, 146242, USA
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  • Michael J. Nabozny
    Affiliations
    Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
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  • Larissa K. Temple
    Affiliations
    Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA

    Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
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  • Fergal J. Fleming
    Affiliations
    Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA

    Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
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      Highlights

      • NSQIP strategies to identify sigmoid volvulus suffer from misclassification bias.
      • Non-operative and palliative care are common management strategies.
      • Earlier surgery during the index admission is associated with improved outcomes.
      • Recurrence rates for sigmoid volvulus are high within the first 6-months.

      Abstract

      Background

      There is limited epidemiologic data on sigmoid volvulus (SV) from non-endemic regions. Therefore, we performed a multicenter study to report contemporary outcomes and appraise literature-based methods that pair diagnostic and procedural codes to identify SV.

      Method

      Using an automated search for patients with ‘volvulus’ in our system from 2011 to 2021, we reviewed electronic charts to clarify the diagnosis, automatically replicate three strategies to identify SV, and retrieved 6-month outcomes.

      Results

      Of 895 patients, 109 had SV. Literature-based strategies poorly identified SV. At the index admission, patients underwent endoscopic reduction alone (33%), emergent (16.5%), semi-elective (34%), or elective (16.5%) surgery. Endoscopic reduction alone had high recurrence rates and delayed surgery was associated with worse outcomes.

      Conclusion

      Literature-based strategies to identify SV suffer from misclassification bias which affects patient counseling. In this large series, one-third of patients do not undergo during their index admission despite improved outcomes with earlier surgery.

      Keywords

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