Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States

  • Dushyant Singh Dahiya (Department of Internal Medicine, Central Michigan University College of Medicine) ;
  • Abhilash Perisetti (Department of Gastroenterology, Parkview Cancer Institute) ;
  • Hemant Goyal (The Wright Center for Graduate Medical Education) ;
  • Sumant Inamdar (Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences) ;
  • Amandeep Singh (Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation) ;
  • Rajat Garg (Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation) ;
  • Chin-I Cheng (Department of Statistics, Actuarial and Data Science, Central Michigan University) ;
  • Mohammad Al-Haddad (Division of Gastroenterology and Hepatology, Indiana University School of Medicine) ;
  • Madhusudhan R. Sanaka (Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation) ;
  • Neil Sharma (Division of Gastroenterology and Hepatology, Indiana University School of Medicine)
  • Received : 2022.06.09
  • Accepted : 2022.08.16
  • Published : 2023.05.30
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Abstract

Background/Aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. Methods: We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. Results: From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p<0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Conclusions: Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

Keywords

Acknowledgement

We analyzed the NIS database from 2007 to 2017, available online at http://www.hcupus.ahrq.gov. The NIS is a large publicly available all-payer inpatient care database in the US that contains data on more than seven million hospital stays annually. Its large sample size is ideal for developing national and regional estimates, and enables analyses of rare conditions, uncommon treatments, and special populations.

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