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The following is a summary of “Comparative analysis of short-term outcomes after semielective and elective surgery for sigmoid volvulus,” published in the August 2024 issue of Surgery by Chu et al.

The optimal timing for surgical intervention following colonic decompression for sigmoid volvulus remains uncertain, with limited data available to inform clinical decision-making. This study aimed to compare postoperative outcomes between patients undergoing semi-selective surgery (performed during the index hospitalization after decompression) and elective surgery (performed during a subsequent elective hospitalization) following decompression for sigmoid volvulus. Researchers conducted a retrospective review of the Medicare Provider Analysis and Review Files from 2016 to 2019, focusing on Medicare beneficiaries aged 65 years and older who were emergently admitted for an initial episode of sigmoid volvulus, underwent colonic decompression, and later received surgical intervention. 

The study included 2,053 patients with a mean age of 78 years (±8 years), of whom 7% underwent elective surgery, and 93% underwent semi-elective surgery, with 12.5% of the latter cohort receiving surgery on the same day as decompression. Bivariate analysis revealed that patients undergoing elective surgery had significantly higher rates of minimally invasive surgery (32.8% vs. 12.6%, P < .001), lower rates of ostomy formation (2.9% vs. 36.0%, P < .001), and a greater likelihood of being discharged home (89.8% vs. 47.4%, P < .001), compared to those undergoing semi elective surgery. Both groups had a similar cumulative length of hospital stay (8 days vs. 9 days, not significant). In a multivariable logistic regression analysis, elective surgery was associated with a significantly reduced risk of postoperative morbidity (odds ratio 0.60; 95% CI 0.49–0.74) and comparable odds of mortality (odds ratio 0.79; 95% CI 0.50–1.25) compared with semi elective surgery. 

These findings remained consistent after excluding patients who underwent surgery on the same day as decompression. The results suggest that elective surgery, performed following colonic decompression for sigmoid volvulus, offers favorable postoperative outcomes, including lower morbidity, reduced ostomy formation, and higher rates of discharge to home when compared to semi-elective surgery. Given the potentially severe consequences of recurrent volvulus, these results underscore the importance of developing algorithms to predict recurrence risk and inform surgical timing, thereby optimizing patient selection for elective surgery.

Source: sciencedirect.com/science/article/abs/pii/S0039606024005609