S. E. Koller2, E. A. Busch2, M. M. Philp2, H. Ross2, H. A. Pitt1,2 1Temple University,Health System,Philadelpha, PA, USA 2Temple University,School Of Medicine,Philadelpha, PA, USA
Introduction: Volvulus is uncommon and frequently occurs in older, frail patients who may be more likely to experience adverse surgical outcomes. Most analyses are single-institution studies performed over long time periods or come from administrative databases with poorly defined surgical outcomes. Thus, the aims of this study were to characterize the risk factors associated with poor outcomes in surgically managed volvulus patients using a large, contemporary database with well-defined 30-day outcomes.
Methods: The 2012 and 2013 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Participant Use Files were employed for this analysis. Standard ACS-NSQIP definitions were used for patient, procedure and outcome data. Eight preoperative variables were combined as a composite to determine patient frailty. Patients with five more of these variables were determined to be frail. Primary outcomes of interest were overall and serious morbidity as well as 30-day mortality. Secondary outcomes included anastomotic leak and return to the operating room (OR). STATA 13.1 was used for univariate analyses and multivariable logistic regression.
Results:Colorectal resection was performed for volvulus in 903 of 29,219 patients (3.1%). The mean age was 49.5 years, but 334 patients (37.0%) were 75 years or older. Three hundred seventy-eight were men (41.9%), 691 were Caucasian (76.5%) and 95 were African American (10.5%). Ninety-five were frail (10.5%) and fourteen had significant weight loss (1.6%). Fifty-eight percent of the operations were performed emergently. A stoma was performed in 164 patients (18.2%), most frequently with partial colectomy (27.2%). Outcomes for all patients as well as for those who were frail or had a stoma are presented in the Table.
Factors that were independently associated with overall morbidity included age 75 years or more (OR 1.62, 95% CI 1.16-2.26, p<0.01), male sex (OR 1.49, 95% CI 1.09-2.02, p<0.02), African American race (OR 1.62, 95% CI 1.01-2.58, p<0.05) and weight loss (OR 5.04, 95% CI 1.50-16.97%, p<0.01). BMI, emergent procedure and operative approach did not influence overall morbidity.
Conclusion:Outcomes of colonic resection for volvulus are worse in the elderly and frail as well as in African Americans and men. Performance of a stoma may reduce the risk of an anastomotic leak. The decision to perform surgery in these high-risk patients should be undertaken with caution.
