EP402 - Current Management of Sigmoid Volvulus: Is Primary Anastomosis Superior?

Sunday, May 11, 2025

12:46 PM – 12:51 PM PT

Location: Monitor 1, Sails Pavilion, Upper Level

ePoster Presenter(s)

Sean H. Nguyen, MD (he/him/his)

Resident
University of Minnesota
Minneapolis, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

CA

Claire Attarian, n/a

Medical Student
University of Minnesota
Minneapolis, Minnesota, United States

Disclosure information not submitted.
Lindsay Welton, MD (she/her/hers)

General Surgery Resident
University of Minnesota
University of Minnesota
Minneapolis, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Lauren Weaver, MD

Resident
University of Minnesota
University of Minnesota
Minneapolis, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
PM

Pravin Meshram, MD, MBBS, MSPH

Research Fellow
University of Minnesota
Minneapolis, Minnesota, United States

Disclosure information not submitted.
Wolfgang Gaertner, MD, MSc, MBA

Professor and Chief, Colon & Rectal Surgery
University of Minnesota
University of Minnesota
Minneapolis, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.

Senior Author(s)

JH

James V. Harmon, Jr., MD, PhD

Associate Professor
University of Minnesota
Minneapolis, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Sean H. Nguyen, MD: This individual has no financial relationships with ineligible companies.

Lindsay Welton, MD: This individual has no financial relationships with ineligible companies.

Lauren Weaver, MD: This individual has no financial relationships with ineligible companies.

Wolfgang Gaertner, MD, MSc, MBA: This individual has no relevant relationships with ineligible companies.

James V. Harmon, MD, PhD, Jr.: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Sigmoid volvulus is an emergent condition that typically requires sigmoidectomy during the index hospital admission. The decision to perform primary colorectal anastomosis versus end colostomy should be individualized based on operative findings and unique patient factors. This study evaluates and compares national outcomes of surgical resection for sigmoid volvulus.

Methods/Interventions: The National Readmission Database was used to retrospectively analyze emergent admissions and readmissions from 2016 to 2021. ICD-10 codes identified adults with sigmoid volvulus who underwent sigmoidectomy with primary anastomosis or colostomy (Hartmann’s) during index admission. Primary outcomes included in-hospital mortality and 30-day hospital readmission. Secondary outcomes included length of hospital stay, discharge disposition, 90-day readmissions, and complications.

Results/Outcomes: A total of 5,528 patients (30.5% women, mean age 69.4±15.6 years) were included (2,225 Hartmann’s and 3,303 primary anastomosis). Of colostomies, 96 (4.3%) were transverse, 1410 (63.4%) descending, and 719 (32.3%) sigmoid. Hartmann’s patients were older (mean 71.8 vs. 67.7 years, P< 0.001) and had higher comorbidity scores (Elixhauser: 2 [1-4] vs. 1 [0-3], P< 0.001; Charlson: 1 [0-2] vs. 0 [0-1], P< 0.001). Payer mix differed, with more Medicare patients undergoing Hartmann’s (79.4% vs. 69.7%, P< 0.001) and more private payers undergoing primary anastomosis (8.9% vs. 17.9%, P< 0.001). Primary anastomosis was associated with lower in-hospital mortality (4.5% vs. 8.5%, P< 0.001) and lower demographic, hospital, and comorbidity adjusted odds of in-hospital mortality (odds ratio 0.58 [0.45-0.73], P< 0.001). 30-day readmission did not differ between the groups (14.7% vs. 13.5%, P=0.21). Hartmann’s patients experienced longer hospital stays (median 11 [7-18] vs. 9 [6-13] days, P< 0.001), more 90-day readmissions (24.5% vs 19.8%, P< 0.001), less home discharges (11.5% vs. 48.1%, P< 0.001), and more all composite complications (44.7% vs. 29.0%, P< 0.001). Analysis of complications showed Hartmann’s was associated with higher rates of venous thrombus (4.5% vs. 1.8%, P< 0.001), pulmonary embolism (1.7% vs. 0.6%, P< 0.001), wound complications (4.3% vs. 2.2%, P< 0.001), shock (1.2% vs. 0.5%, P=0.004), myocardial infarction (2.9% vs. 1.1%, P< 0.001), genitourinary complications (18.2% vs. 10.8%, P< 0.001), and respiratory complications (12.1% vs. 4.5%, P< 0.001).

Conclusion/Discussion: In this large national database review of patients undergoing sigmoidectomy for volvulus, 40% of patients underwent a Hartmann’s procedure rather than primary anastomosis. Hartmann’s was associated with higher in-hospital mortality, hospitalization length, 90-day readmission, composite complications, most individual complications, and non-home discharge. These findings suggest Hartmann’s carries higher morbidity and mortality in the setting of sigmoid volvulus. Primary anastomosis should be considered when feasible.