Patience is key: Association of surgical timing with clinical outcomes in elderly patients with sigmoid volvulus.

Background: Current guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (>2 days) sigmoid colectomy.

Methods: 2016-2019 NRD database was queried to identify patients aged ≥65 years admitted for sigmoid volvulus who underwent sequential endoscopic decompression and sigmoid colectomy. Outcomes included mortality, complications, hospital length of stay, readmissions, and hospital costs.

Results: 842 patients were included, of which 409 (48.6 ​%) underwent delayed sigmoid colectomy. Delayed sigmoid colectomy was associated with reduced cardiac complications (1.1 ​% vs 0.0 ​%, p ​= ​0.045), reduced ostomy rate (38.3 ​% vs 29.4 ​%, p ​= ​0.013), an increased overall length of stay (12 days vs 8 days, p ​< ​0.001) and increased overall costs (27,764 dollar vs. 24,472 dollar, p ​< ​0.001).

Conclusion: In geriatric patient with sigmoid volvulus, delayed surgical resection after decompression is associated with reduced cardiac complications and reduced ostomy rate, while increasing overall hospital length of stay and costs.