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What are the results of colonic volvulus surgery?

AbstractBACKGROUND:
Operative results of volvulus are largely unknown because of infrequent diagnosis.
OBJECTIVE:
We examined the results of operative intervention for colonic volvulus.
DESIGN:
We merged trackable data from the California Inpatient Database with Supplemental Files for Revisit Analyses between January 1, 2005, and December 31, 2007.
SETTINGS:
Trackable data from California discharge records.
PATIENTS:
We identified all of the patients with colonic volvulus who underwent 1 of 4 surgical procedures, including manipulation/fixation of the colon, right colectomy, left colectomy, or total colectomy.
MAIN OUTCOME MEASURES:
During the 36-month study period, we identified recurrence risk, recurrence requiring reoperation, time to reoperation, stoma formation, disposition on discharge, and in-hospital mortality. Fisher exact, χ(2), and ANOVA tests were used when appropriate.
RESULTS:
We identified 2141 patients with colonic volvulus who were undergoing intraoperative manipulation/fixation of the colon (n = 209 (12%)), right (n = 728 (41%)), left (n = 781 (44%)), or total colectomy (n = 56 (3%)). Patients treated with intraoperative manipulation/fixation were younger, more likely to be women, and more likely to have private insurance. Patients who underwent total colectomy had the highest risk of mortality (21%), highest risk of stoma creation (64%), and longest length of stay (18 days); were more likely to be readmitted (9%); and were the most likely to be discharged to a skilled nursing facility (48%). Patients treated with intraoperative manipulation/fixation had the lowest mortality, risk of stoma formation, length of stay, and likelihood of discharge to skilled nursing facility but the highest risk of subsequent procedures for volvulus (26%) over a follow-up ranging from 0 to 687 days.
LIMITATIONS:
This study was limited by retrospective study design, heterogeneous patient factors, and inability to identify the time of last follow-up.
CONCLUSIONS:
The majority of patients with volvulus underwent a resectional procedure. A subset without resection had favorable initial outcomes but remained at high risk for subsequent procedures. There may be a potential role for evaluating intraoperative manipulation/fixation in a small subset of patients with colonic volvulus.
AuthorsKevin R Kasten, Peter W Marcello, Patricia L Roberts, Thomas E Read, David J Schoetz, Jason F Hall, Todd D Francone, Rocco Ricciardi
JournalDiseases of the colon and rectum (Dis Colon Rectum) Vol. 58 Issue 5 Pg. 502-7 (May 2015) ISSN: 1530-0358 [Electronic] United States
PMID25850837 (Publication Type: Journal Article)
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • California
  • Colectomy
  • Colonic Diseases (surgery)
  • Colostomy
  • Female
  • Hospital Mortality
  • Humans
  • Intestinal Volvulus (surgery)
  • Length of Stay
  • Male
  • Middle Aged
  • Recurrence
  • Reoperation
  • Retrospective Studies
  • Suture Techniques
  • Treatment Outcome

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