311 A Twist in the Tale - Study of the Management of Sigmoid Volvulus (SV)

Aim

As SV has no current NICE guidance, nor large UK reviews, there is a requirement to outline best practice in the management. A review was undertaken of SV cases to determine how variation in management affects outcomes.

Method

Forty five patients (35:10 M:F) (median age 79 years, 29-93) with SV contributing 95 admissions 2017-2019 were studied using electronic notes and imaging. Estimated costs per patient were calculated using national tariff documents.

Results

Two groups were identified: conservative (non-operative management) (n = 39) and operative (n = 6), with a 90-day mortality of 41.02% and 16.67% respectively. Mean total days in hospital for each patient was 28.49 (range 1-215), 18.17 for operative and 30.08 for conservative. Nineteen patients had readmissions for SV 2017-2019, 30 in 2013-2021. No readmissions occurred post-surgery. Estimated cost of SV admissions 2017-2019 was £934,151, with no significant difference in cost for operative versus conservative.

Rigid sigmoidoscopy was performed in 65.26% (n = 62) of admissions, 38.71% (n = 24) were successful. Flexible sigmoidoscopy was performed in 61.05% (n = 58) of admissions, 17 without rigid. Decompression was achieved in 72.41% (n = 42) with flexible more successful than rigid sigmoidoscopy (p = <0.0001).

Conclusions

SV patients are mostly male, older, co-morbid and managed conservatively. Mortality is high but reduced in patients managed surgically. Without surgery, patients had multiple admissions, decompressions, and long hospital stays, leading to increased costs. This project recommends the consideration of surgery in order to improve patient outcomes. A prospective large-scale study is required to improve data.