The 30-day perioperative outcomes of sigmoid volvulus surgery in resource-limited setting in Northcentral Ethiopia

Abstract

Sigmoid volvulus remains a leading cause of intestine obstruction in low middle income countries, particularly in volvulus belt countries. The objective of this study to explore the morbidity and mortality after sigmoid volvulus surgery in Northcentral Ethiopia. Hospital-based retrospective cohort study employed in Debre Tabor comprehensive specialised hospital Northcentral Ethiopia. A medical chart reviews were conducted from Jan1, 2016 to June 30,206. The collected data checked manually for completeness and consistency. The final data coded and entered to SPSS version 27 for data processing and analysis. Univariable and multivariable binary logistic regression analysis conducted to identified attributable factors for morbidity and mortality after sigmoid volvulus surgery. The result of the final model expressed in terms of adjusted Odd Ratios (AOR) and 95% CI and statistical significance declared if the p-value is less than 0.05. Three hundred sixty-two patients were analysed. Mean age was 56.4(SD14.5), with male predominance (321/362,88.7%) and most patients had anesthesia low risk (ASA grade 2, 230/362,63.5%). Emergency procedures were performed in 187/362(51.7%). Gangrenous sigmoid was found for 139/362 (38·4%) patients, 139/187(74.3%) of patients who underwent emergency surgery. The overall 30-day complication rate was 80 (22.1%) of 362, and mortality was 19/362(5.5%). 30-day postoperative complications were significantly associated with ASA IV (adjusted odds ratio AOR = 13.1, 95%CI:12.6–66.3; p = 0.002), presence of comorbidity (AOR = 4.4, 2.0-9.9; p < 0.0001), emergency procedures (AOR = 11.7, 3.6–37.9; p = 0.025), and gangrenous bowel intraoperative viability (AOR = 2.5, 1.2–5.7; p = 0.25). More than half of patients underwent emergency surgery, and two-thirds of these had intraoperative gangrenous bowel. Perioperative complication rates were high among patients undergoing emergency surgery and among those with comorbidities and higher ASA grades, despite most patients being classified as low surgical risk. Improving access to bellwether surgery, strengthening processes of care, and building surgical capacity and health-system delivery could help achieve safe, equitable surgical care for sigmoid volvulus.