Association for Academic Surgery Perioperative Outcomes and Predictors of Mortality After Surgery for Sigmoid Volvulus Anthony Easterday, MD, Sarah Aurit, MPH, Rebecca Driessen, BS, Austin Person, MD, and Devi Mukkai Krishnamurty, MBBS* Department of Surgery, CHI Health Creighton University Medical Center-Bergan Mercy, Omaha, Nebraska article info Article history: Received 1 March 2019 Received in revised form 8 July 2019 Accepted 16 July 2019 Available online 12 August 2019 abstract Background: Data on outcomes after surgery for sigmoid volvulus is limited. The aim of this study was to develop a model to predict need for emergent surgery and mortality after resection for sigmoid volvulus. Methods: The NSQIP database was queried from 2012 to 2016 to identify patients undergoing segmental resection for sigmoid volvulus. Pre-, intra-, and post-operative variables were compared. Primary and secondary outcomes were emergent surgery and risk of mortality, respectively. Chi-square and Fischer’s test for categorical variables and the ManneWhitney test for continuous variables were used. Significant variables for each outcome were entered into a logistic regression model to predict the outcomes. Results: 2086 patients met inclusion criteria. Factors associated with emergency surgery included female gender, relative hematocrit elevation, relative leukocytosis, acute kidney injury, preoperative sepsis, prior functional independence, and bleeding disorders. Laparo- scopic resection and mechanical bowel preparation were more commonly used in the non- emergent setting. Patients having emergent resection were more likely to suffer from postoperative superficial surgical site infection, pneumonia, cardiac arrest, septic shock, myocardial infarction, and receive perioperative transfusion. No difference was seen in ileus, readmission or reoperation rates in the emergent and nonemergent groups. Factors predictive of postoperative mortality included increased age, systemic sepsis, and emergent surgery. In- dependence before illness, higher albumin levels, and lower BMI were shown to be protective. Conclusions: Emergent resection is independently associated with poor postoperative out- comes and mortality. Predictors of need for emergent resection and mortality identified in this study can be used to aid in shared decision-making for patients with sigmoid volvulus. ª 2019 Elsevier Inc. All rights reserved. Introduction Colonic volvulus is a closed loop obstruction caused by rota- tion of a loop of colon along its mesenteric axis which can rapidly progress to ischemia, gangrene, and perforation of the involved bowel segments. 1 Anatomically, a volvulus can occur in the sigmoid colon, cecum, transverse colon, or splenic flexure, in order of decreased rate of occurrence. 2 It is the third most common cause of bowel obstruction, after cancer and diverticular disease, although its incidence varies with * Corresponding author. CHI Health Creighton University Medical Center- Bergan Mercy, 7710 Mercy Rd Suite 501, Omaha, NE 68124. Tel.: þ1 2403283435; fax: (402) 717-6063. E-mail address: Devi.krishnamurty@alegent.org (D.M. Krishnamurty). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  january 2020 (245) 119 e126 0022-4804/$ e see front matter ª 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2019.07.038