Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study

Figures & data

Table 1 Socio-Demographic Characteristics and Mode Arrival of Post-Emergency Laparotomy Sigmoid Volvulus Patients at Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia, from January 1, 2020, to December 31, 2022

Variables	Category	Number	Percent
Age	<60	120	70.6
	≥60	50	29.4
Sex	Male	149	87.6
	Female	21	12.4
Residence	Rural	152	89.4
	Urban	18	10.6
Mode of arrival	By themselves	118	69.4
	By ambulance	58	30.6
Referral	Yes	136	80
	No	34	20
Arrival following referral	Within 24 hours	126	74
	Beyond 24 hours	44	26

Table 2 Clinical Presentation and Characteristics of Patients Who Underwent Emergency Laparotomy for Sigmoid Volvulus at Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia, from January 1, 2020, to December 31, 2022

Characteristics	Category	Number	Percent
Abdominal pain	Yes	160	94.1
	No	10	5.9
Constipation	Yes	162	95.3
	No	8	4.7
Distension	Yes	144	84.7
	No	26	15.3
Vomiting	Yes	104	61.2
	No	66	38.8
Duration of symptoms	≤24 hours	54	31.8
	>24 hours	116	68.2
Abdominal X-ray	Yes	90	52.9
	No	80	47.1
ASA score	I	84	49.7
	>I	85	50.3
Comorbidity	Yes	15	8.9
	No	152	91.1
Pulse rate at presentation	<90	85	51.2
	≥90	81	48.8
Hypotensive at presentation	Yes	19	11.7
	No	144	88.3
Fever	Yes	13	7.7
	No	156	92.3
Indication	Suspected gangrenous	106	62.4
	Failed deflation	64	37.6

Abbreviation: ASA, American Society of Anesthesiologists.

Table 3 Treatment Modalities and Intra-Operative Findings of Patients Who Underwent Emergency Laparotomy for Sigmoid Volvulus at Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia, from January 1, 2020, to December 31, 2022

Findings	Category	Number	Percent
Intra-operative diagnosis (N=170)	Sigmoid volvulus	150	88.2
	Ileosigmoid knotting	20	11.8
Bowel viability (N=167)	Gangrenous	94	56.3
	Viable	73	43.7
Type of procedure (N=170)	REEA	104	61.2
	Resection and colostomy	66	38.8
Pus and/or fecal matter contamination of peritoneum (N=157)	Yes	18	11.5
	No	139	88.5
Duration of surgery (N=170)	<1hr	22	12.9
	≥1hr	148	87.1

Table 4 Perioperative Adverse Outcomes Among Post-Emergency Laparotomy Sigmoid Volvulus Patients at Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia, from January 1, 2020, to December 31, 2022

Adverse Outcome	Category	Number	Percent
Pneumonia (N=166)	Yes	29	17.5
	No	137	82.5
Surgical site infection (N=167)	Yes	19	11.4
	No	148	88.6
Dehiscence (N=167)	Yes	10	6.0
	No	157	94.0
Anastomotic leak (N=170)	Yes	8	4.7
	No	162	95.3
Acute kidney injury (N=166)	Yes	7	4.2
	No	159	95.8
Stoma complications	Yes	5	3.0
	No	162	97.0
Status on discharge	Alive	157	92.4
	Dead	13	7.6

Table 5 Bivariable and Multivariable Logistic Regression Analyses of Post-Emergency Laparotomy Sigmoid Volvulus Patients at Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia, from January 1, 2020, to December 31, 2022

Characteristics	Category	Adverse Outcome	Good Outcome	COR(95% CI)	AOR (95% CI)
Age	≥60	20	30	2.09[1.03, 4.22]	2.36[0.99, 5.61]
	<60	29	91	1	1
ASA score	>I	32	53	2.38[1.19, 4.74]	2.37[1.05, 5.34]*
	I	17	67	1	1
Comorbidity	Yes	8	7	3.094[1.05, 9.07]	3.45[0.92, 12.86]
	No	41	111	1	1
Pulse rate at presentation	≥90	29	52	1.93[0.97, 3.83]	1.06[0.39, 2.88]
	<90	19	66	1	1
Hypotensive at presentation	Yes	12	7	5.76[2.60, 12.74]	3.87[1.22, 12.28]*
	No	37	107	1	1
Fever	Yes	6	7	2.25[0.71, 7.08]	1.63[0.32, 8.30]
	No	43	113	1	1
Indication	Suspected gangrenous	38	68	2.69[1.25, 5.76]	1.25[0.40, 3.89]
	Failed deflation	11	53	1	1
Procedure	Resection + colostomy	24	42	1.80[0.92, 3.54]	1.15[0.38, 3.44]
	REEA	25	79	1	1
Bowel ischemia	Yes	32	62	1.70[0.85, 3.39]	1.18[0.40, 3.43]
	No	17	56	1	1
Pus or fecal matter contamination of the peritoneum	Yes	11	7	4.33[1.56, 12.00]	4.43[1.35, 14.47]*
	No	37	102	1	1

Note: *Significant predictor at p <0.05.

Abbreviation: ASA, American Society of Anesthesiologists.