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Predicting Factors for Mortality in Sigmoid Volvulus

Keywords: Sigmoid volvulus , mortality , predicting factors

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Abstract:

Sigmoid colon is the most frequent site for a volvulus and volvulus of the sigmoid colon(SV) is characterized by a high morbidity and mortality. The objective of this study was toevaluate predicting factors for mortality in the SV cases. Between January 1994 andDecember 2001, the records of patients operated on due to SV at Dicle University Hospital(DUH) were retrospectively reviewed. The epidemiological, clinical, and laboratory featureswere evaluated as probable risk factors for mortality. Variables associated with SV weredetermined using logistic regression models. Of 90 patients, 80 (88.9%) were male, and 10(11.1%) were female. The mean age was 58.8±12.9 (19-85) and 63.6±16.1 (23-83) for thepatients with uneventful outcome (Group 1) and for the patients with fatal outcome (Group2), respectively (p=0.000). The period of symptoms before admission (PSBA) were 2.2±0.73(1-4) days and 5.6±1.7 (2-10) days in Group 1 and Group 2 respectively (p=0.000). While the73.8 % of patients in the Group 1 were operated on an emergency state, 100 % of patients inthe Group 2 were operated on an emergency state (p=0.002). In the univariate analysis, othersignificant risk factors were significantly fluid-electrolyte imbalance, elevated abdominalpressure (EAP), cardiovascular disease, respiratory disease, leukocytosis, hypotension,presence of necrosis, and presence of major contamination (p=0.000). These variables wereentered into the logistic regression model for revealing the risk factors for mortality. Inmultivariate analysis, long PSBA [Odds Ratio (OR) =17.17, 95% Confidence Interval (CI)=2.86-103.07, P=0.002], presence of cardiovascular disease at the admission (OR=0.19,CI=0.001-0.52, P=0.019) and age (OR=0.87, CI=0.77-0.99, P=0.046) were foundsignificantly predictive for mortality. EAP, fluid-electrolyte imbalance, respiratory disease,and presence of major contamination were not statistically significant factors for mortalityafter sigmoid volvulus. In our study, we determined that conditions, such as a long PSBA,presence of cardiovascular disease and age were predicting factors for mortality.

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