Retrospective analysis of mortality and morbidity in sigmoid volvulus

Sigmoid volvulus usually occurs in frailer patients with comorbidities and can be associated with recurrence. Our exploratory study assessed long-term outcomes in this cohort. We retrospectively reviewed the records of patients admitted with sigmoid volvulus to two inner-city acute surgical units from 2016 to 2023, noting the clinical frailty scale (CFS), number of readmissions, treatment and 12-month mortality. Seventy-five patients met our criteria. The mean age was 74 years, and the median CFS was 5. Forty-eight percent of the subsequent readmissions were related to sigmoid volvulus. The 12-month mortality rate after initial presentation was 19%; this figure was 50% in patients with CFS > 7. Thirty-six percent of people were operated on, either during the first or a subsequent admission (only 3 of whom had CFS > 5), with 0% mortality. Higher mortality and functional decline were observed among patients who presented with sigmoid volvulus; however, short- to medium-term survival was better in operated patients, although this may be due to the selection basis. The subgroup of frail patients who underwent surgery was too small to meaningfully conclude outcomes in this subgroup. The high mortality rate among sigmoid volvulus patients with CFS > 7 may encourage a move towards early advanced-care planning and palliation, avoiding the burden of subsequent readmissions.