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.
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.
From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (
Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.
Large bowel obstruction is a frequent cause of hospitalization and may occur due to various benign or malignant causes.
In the United States (US), CV is the third most common cause of bowel obstruction in colorectal cancer and diverticulitis, accounting for approximately 3.5% of all bowel obstructions.
The study cohort was obtained from the National Inpatient Sample (NIS) database. As part of the Healthcare Cost and Utilization Project, the NIS gathers data on inpatient admissions submitted by hospitals across the US to state-wide data organizations, covering more than 95% of the US population.
We identified all adult (≥18 years) hospitalizations with a primary discharge diagnosis of CV in the US from 2007 to 2017. These hospitalizations were further divided into two subgroups based on endoscopic or surgical management for comparative analysis. Endoscopic management primarily consisted of endoscopic detorsion via sigmoidoscopy or colonoscopy. Surgical management was defined as surgical resection of the bowel segment. Patients who underwent surgery after failure of endoscopic management were included in the surgical management subgroup for the analysis.
Statistical analysis was conducted using Statistical Analysis System (ver. 9.4; SAS Institute Inc.) while accounting for the weights in the stratified survey design. The weights were considered during statistical estimation by incorporating variables for strata (stratum used to post-stratify hospitals), cluster (Healthcare Cost and Utilization Project hospital identification number), and weight (weight to discharges) in the NIS database. Descriptive statistics were provided, including the mean (standard deviation) for continuous variables and count (percentage) for categorical variables. The Cochran-Armitage trend test was used to test the trend of the proportions of the binary variables in years. The trend of the averages of the continuous variables in years was examined using linear regression. The Rao-Scott design-adjusted chi-square test, which considers a stratified survey design, examined the association between two categorical variables. Differences in the means for age, length of stay (LOS), and total healthcare charge (THC) between the endoscopic and surgical interventions were tested using F-statistics from the weighted regression model. Adjusted hazard ratios with 95% confidence intervals were obtained through Cox proportional hazard regression, which modeled factors that influenced age at death. All analytical results were considered statistically significant at
The NIS database lacks patient- and hospital-specific identifiers. Hence, this study was exempt from the institutional review board (IRB) review, as per the guidelines put forth by our institutional IRB for research on database studies. Hence, no consent was required for NIS studies.
Between 2007 and 2017, there were 220,666 hospitalizations for CV in the US. There was a trend toward increasing total CV hospitalizations in the US, from 17,888 in 2007 to 21,715 in 2017 (
In the US, inpatient mortality for CV hospitalizations decreased from 7.6% in 2007 to 6.2% in 2017 (
During the study period, 13,745 patients hospitalized for CV underwent endoscopic intervention, whereas 77,157 were managed with surgery. Patients in the surgical cohort were older (70.1 vs. 66.3 years,
The endoscopic intervention cohort had a lower all-cause inpatient mortality (6.1% vs. 7.0%,
For endoscopic CV management, males had a 70.9% higher mortality risk than females after adjusting for other variables. Increased CCI scores were also associated with increased risk of inpatient mortality (
For surgical CV management, males had a 19.9% higher mortality risk than females after adjusting for other variables. Additionally, for patients hospitalized for CV that underwent surgical management, the presence of acute kidney injury, chronic obstructive pulmonary disease, malnutrition, and obesity were associated with 249.6%, 29.9%, 20.4%, and 56.4% higher risks of inpatient mortality, respectively, than those without these complications, after adjusting for confounders such as patient and hospital characteristics (
Our study noted a rising trend of CV hospitalizations from 17,888 in 2007 to 21,715 in 2017, with a decline in overall all-cause inpatient mortality. Despite a higher proportion of patients with CCI score ≥1 and associated comorbidities, endoscopic management had lower inpatient mortality, shorter mean LOS, and lower mean THC than surgical management for CV hospitalizations. The identification of trends, associations, clinical outcomes, and a comparative analysis of treatment strategies for CV hospitalizations is essential, as it provides gastroenterologists with real-world data on patients who might be at the highest risk of developing CV and those who may benefit the most from minimally invasive endoscopic interventions compared to conventional surgery.
Previous studies have reported that patients with chronic constipation, opioid users, and older patients are more likely to develop CV compared to the general population.
Although patients may undergo endoscopic detorsion for CV, surgical resection is warranted in severe cases to prevent recurrence. Hence, there are more surgical resections compared to non-surgical decompression for CV.
Endoscopic therapy for CV may be appropriate in patients with multiple comorbidities despite surgical resection being the traditional practice.
During the 2007–2017 study period, the mean LOS for CV hospitalizations decreased from 10.2 days in 2007 to 8.8 days in 2017. This may be attributed to improved inpatient management strategies and the widespread availability of endoscopic intervention, which is a less invasive approach for CV. However, the mean THC for CV hospitalization increased from $64,447 in 2007 to $100,928 in 2017. This may, in part, be secondary to the involvement of a multidisciplinary team of specialists and ancillary healthcare professionals in managing complex patients and complications. Moreover, compared with surgical management, the endoscopic intervention cohort had a shorter mean LOS (8.3 vs. 11.8 days,
This study has several strengths and limitations. The study population, derived from a large, multi-ethnic, publicly available database, was a key strength of this study. The NIS database contains information on inpatient hospital stays from hospitals across the US, covering 97% of the US population. Hence, the outcomes derived from this study are applicable and generalizable to hospitalizations in the US. The 11-year study period from 2007 to 2017 allowed us to establish meaningful trends and outcomes, in addition to the current literature. Additionally, through the unique study design, we not only focused on hospitalization characteristics, clinical outcomes, and associations of CV but also compared the differences in endoscopic and surgical management for CV. This allowed for extensive analysis and helped to assess the disease entity thoroughly. Despite its numerous strengths, we acknowledge the limitations of our study. The NIS database does not contain data on the severity of CV, the methods used to establish a diagnosis, or the hospital course. We were unable to assess the impact of pharmacotherapy in the management of CV, which could have impacted the findings of this study. Finally, the NIS is an administrative database that uses ICD codes to store information; hence, the possibility of coding errors cannot be excluded. Despite these limitations, the large sample size, unique methodology, and comprehensive analysis techniques help us to better understand the disease entity. This article aims to stimulate conversations and promote further research on CV.
In conclusion, there was an increase in CV hospitalizations between 2007–2017; however, all-cause inpatient mortality declined. In addition to other risk factors, CV hospitalization for patients with chronic constipation and opioid use has increased. Endoscopic therapy was associated with lower inpatient mortality, LOS, and THC than surgery. In the absence of colonic ischemia or perforations associated with CV, endoscopic therapy may be an excellent alternative to surgery in appropriately selected patients and should be offered as a treatment modality for CV hospitalization.
The authors have no potential conflicts of interest.
None.
We analyzed the NIS database from 2007 to 2017, available online at
Conceptualization: DSD, AP, HG, NRS; Data curation: DSD, CIC; Formal analysis: CIC; Investigation: all authors; Methodology: DSD, AP, HG, CIC, NRS; Project administration: DSD, MAH, MRS, NRS; Resources: DSD, CIC; Software: CIC; Supervision: DSD, MAH, MRS, NRS; Validation: all authors; Visualization: all authors; Writing–original draft: DSD, AP, HG; Writing–review & editing: all authors.
Trends of Charlson comorbidity index (CCI) for colonic volvulus-related hospitalizations in the United States from 2007 to 2017.
Trends of inpatient mortality, opioid use, and chronic constipation for colonic volvulus-related hospitalizations in the United States from 2007 to 2017.
Comparison of Charlson comorbidity index (CCI) for endoscopic and surgical management of colonic volvulus-related hospitalizations in the United States from 2007 to 2017.
Hospitalization characteristics for colonic volvulus in the United States from 2007 to 2017
Epidemiological variable | Year |
Trend ( |
|||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2007–2017 | ||
Total no. of hospitalizations | 17,888 | 19,388 | 19,389 | 19,408 | 20,748 | 18,990 | 20,700 | 20,525 | 20,990 | 20,925 | 21,715 | 22,0666 | Increase (0.0006) |
Mean age (yr) | 67.0 | 66.0 | 66.3 | 66.2 | 66.0 | 66.0 | 66.0 | 66.5 | 66.3 | 66.4 | 66.2 | 66.3 | No trend (0.6317) |
Age group (yr) | |||||||||||||
18 |
1,072(6.0) | 1,284 (6.6) | 1,261 (6.5) | 1,315 (6.8) | 1,288 (6.2) | 1,255(6.6) | 1,475 (7.1) | 1,225(6.0) | 1,435 (6.8) | 1,285 (6.1) | 1,475 (6.8) | 14,370 (6.5) | No trend(0.1110) |
35 |
2,236 (12.5) | 2,478 (12.8) | 2,432 (12.5) | 2,240 (11.5) | 2,619 (12.6) | 2,400 (12.6) | 2,400 (11.6) | 2,445 (11.9) | 2,185 (10.4) | 2,330 (11.1) | 2,435 (11.2) | 26,200 (11.9) | Decrease (<0.0001) |
50 |
3,586 (20.1) | 4,372 (22.6) | 4,322 (22.3) | 4,587 (23.6) | 5,101 (24.6) | 4,280 (22.5) | 4,745 (22.9) | 4,705 (22.9) | 5,015 (23.9) | 4,790 (22.9) | 4,950 (22.8) | 50,453 (22.9) | Increase (<0.0001) |
65 |
5,614 (31.4) | 5,611 (28.9) | 5,753 (29.7) | 5,787 (29.8) | 6,030 (29.1) | 5,715 (30.1) | 6,420 (31.0) | 6,175 (30.1) | 6,500 (30.1) | 6,825 (32.6) | 6,940 (32.0) | 67,370 (30.5) | Increase (<0.0001) |
≥80 | 5,380 (30.1) | 5,643 (29.1) | 5,620 (29.0) | 5,478 (28.2) | 5,710 (27.5) | 5,340 (28.1) | 5,660 (27.3) | 5,975 (29.1) | 5,855 (27.9) | 5,695 (27.2) | 5,915 (27.2) | 62,272 (28.2) | Decrease (<0.0001) |
Sex | |||||||||||||
Male | 7,823 (43.8) | 8,690 (44.8) | 8,601 (44.4) | 8,645 (44.6) | 9,068 (43.8) | 8,460 (44.6) | 9,100 (44.0) | 9,620 (46.9) | 9,600 (45.7) | 9,450 (45.2) | 9,860 (45.4) | 98,917 (44.8) | Increase (<0.0001) |
Female | 10,057 (56.3) | 10,693 (55.2) | 10,777 (55.6) | 10,749 (55.4) | 11,657 (56.2) | 10,530 (55.5) | 11,595 (56.0) | 10,900 (53.1) | 11,390 (54.3) | 11,470 (54.8) | 11,855 (54.6) | 121,672 (55.1) | Decrease (<0.0001) |
Race | |||||||||||||
White | 10,190 (76.4) | 12,166 (77.2) | 12,329 (74.2) | 13,009 (74.7) | 14,256 (75.8) | 13,350 (74.8) | 14,640 (75.3) | 14,465 (74.8) | 14,475 (73.8) | 14,765 (74.8) | 15,275 (73.3) | 148,920 (74.9) | Decrease (<0.0001) |
Black | 1,547 (11.6) | 1,914 (12.1) | 2,231 (13.4) | 2,479 (14.2) | 2,429 (12.9) | 2,480 (13.9) | 2,640 (13.6) | 2,850 (14.7) | 2,730 (13.9) | 2,840 (14.4) | 3,095 (14.9) | 27,235 (13.7) | Increase (<0.0001) |
Hispanic | 864(6.5) | 913(5.8) | 1,156 (7.0) | 1,127 (6.5) | 1,420 (7.6) | 1,085 (6.1) | 1,250 (6.4) | 1,175(6.1) | 1,485 (7.6) | 1,230 (6.2) | 1,505 (7.2) | 13,211 (6.7) | Increase (0.0033) |
Asian | 326(2.5) | 353(2.2) | 309(1.9) | 265 (1.5) | 221(1.2) | 285(1.6) | 440(2.3) | 295(1.5) | 370(1.9) | 355 (1.8) | 375(1.8) | 3,594(1.8) | Decrease (0.0037) |
Native American | 94(0.7) | 79(0.5) | 91(0.5) | 143(0.8) | 66(0.4) | 100(0.6) | 70(0.4) | 95(0.5) | 115(0.6) | 110(0.6) | 85(0.4) | 1,048(0.5) | Decrease (0.0017) |
Other | 312(2.3) | 342(2.2) | 502(3.0) | 388 (2.2) | 411(2.2) | 545(3.1) | 410(2.1) | 460(2.4) | 450(2.3) | 450(2.3) | 495(2.4) | 4,764(2.4) | No trend (0.1023) |
Charlson comorbidity index | |||||||||||||
0 | 8,053 (45.0) | 8,488 (43.8) | 8,180 (42.2) | 7,969 (41.1) | 8,683 (41.9) | 7,860 (41.4) | 8,545 (41.3) | 8,315 (40.5) | 8,565 (40.8) | 8,310 (39.7) | 8,465 (39.0) | 91,433 (41.4) | Decrease (<0.0001) |
1 | 4,430 (24.8) | 5,180 (26.7) | 4,695 (24.2) | 4,727 (24.4) | 5,124 (24.7) | 4,590 (24.2) | 5,095 (24.6) | 5,040 (24.6) | 4,865 (23.2) | 4,845 (23.2) | 5,255 (24.2) | 53,847 (24.4) | Decrease (<0.0001) |
2 | 2,729 (15.3) | 2,921 (15.1) | 3,169 (16.3) | 2,967 (15.3) | 3,185 (15.4) | 2,940 (15.5) | 3,215 (15.5) | 3,240 (15.8) | 3,215 (15.3) | 3,155 (15.1) | 3,090 (14.2) | 33,827 (15.3) | Decrease (0.0026) |
≥3 | 2,676 (15.0) | 2,798 (14.4) | 3,344 (17.3) | 3,745 (19.3) | 3,755 (18.1) | 3,600 (19.0) | 3,845 (18.6) | 3,930 (19.2) | 4,345 (20.7) | 4,615 (22.1) | 4,905 (22.6) | 41,559 (18.8) | Increase (<0.0001) |
Associations | |||||||||||||
Opioid use | 33(0.2) | 39(0.2) | 66(0.3) | 90(0.5) | 99(0.5) | 110(0.6) | 140(0.7) | 140(0.7) | 145(0.7) | 235(1.1) | 210(1.0) | 1,306(0.6) | Increase (<0.0001) |
Multiple sclerosis | 144(0.8) | 148(0.8) | 108(0.6) | 174(0.9) | 163(0.9) | 165(0.9) | 140(0.7) | 160(0.8) | 205(1.0) | 170(0.8) | 185(0.9) | 1,762(0.8) | Increase (0.0186) |
Parkinson’s disease | 453(2.5) | 487(2.5) | 579(3.0) | 506 (2.6) | 556(2.7) | 545(2.9) | 515(2.5) | 540(2.6) | 685(3.3) | 810(3.9) | 785(3.6) | 6,461 (2.9) | Increase (<0.0001) |
Epilepsy | 392(2.2) | 722(3.7) | 803(4.1) | 843(4.3) | 882(4.3) | 850(4.5) | 1,060(5.1) | 1,080(5.3) | 980(4.7) | 1,095 (5.2) | 1,140 (5.3) | 9,847(4.5) | Increase (<0.0001) |
Depression | 79(0.4) | 140(0.7) | 139(0.7) | 149(0.8) | 178(0.9) | 170(0.9) | 210(1.0) | 260(1.3) | 780(3.7) | 2,770 (13.2) | 2,920 (13.5) | 7,795(3.5) | Increase (<0.0001) |
Anxiety | 556(3.1) | 737(3.8) | 697(3.6) | 853(4.4) | 1,158 (5.6) | 1,440(7.6) | 2,010 (9.7) | 2,040(9.9) | 2,385 (11.4) | 2,680 (12.8) | 2,595 (12.0) | 17,151 (7.8) | Increase (<0.0001) |
Migraines | 141(0.8) | 176(0.9) | 188(1.0) | 223(1.2) | 282(1.4) | 270(1.4) | 330(1.6) | 315(1.5) | 280(1.3) | 340(1.6) | 370(1.7) | 2,915(1.3) | Increase (<0.0001) |
Attention deficit hyperactivity disorder | 44(0.3) | 35(0.2) | 36(0.2) | 39(0.2) | 91(0.4) | 70(0.4) | 100(0.5) | 90(0.4) | 120(0.6) | 130(0.6) | 105(0.5) | 859(0.4) | Increase (<0.0001) |
Chronic constipation | 1,398(7.8) | 1,518 (7.8) | 1,902 (9.8) | 2,147 (11.1) | 2,442 (11.8) | 2,245 (11.8) | 2,640 (12.8) | 2,745 (13.4) | 2,700 (12.9) | 2,225 (10.6) | 2,520 (11.6) | 24,482 (11.1) | Increase (<0.0001) |
Disposition | |||||||||||||
Discharge home | 9,029 (50.5) | 9,768 (50.4) | 9,657 (49.8) | 9,545 (49.2) | 10,705 (51.7) | 9,805 (51.7) | 10,650 (51.5) | 10,555 (51.5) | 10,500 (50.1) | 10,270 (49.1) | 10,860 (50.1) | 111,343 (50.5) | No trend (0.2320) |
Transfer to short-term hospital | 416(2.3) | 597(3.1) | 487(2.5) | 514(2.7) | 583(2.8) | 475(2.5) | 505(2.4) | 465 (2.3) | 570 (2.7) | 460 (2.2) | 585 (2.7) | 5,657 (2.6) | Decrease (0.0267) |
Transfer to another facility (includes skilled nursing facility, intermediate care facility) | 4,705 (26.3) | 4,965 (25.6) | 5,248 (27.1) | 5,319 (27.4) | 5,172 (25.0) | 4,775 (25.2) | 5,300 (25.6) | 5,185 (25.3) | 5,345 (25.5) | 5,585 (26.7) | 5,400 (24.9) | 56,999 (25.9) | Decrease (0.0004) |
Home health care | 2,305 (12.9) | 2,494 (12.9) | 2,454 (12.7) | 2,562 (13.2) | 2,718 (13.1) | 2,510 (13.2) | 2,845 (13.8) | 2,790 (13.6) | 3,025 (14.4) | 3,040 (14.5) | 3,320 (15.3) | 30,064 (13.6) | Increase (<0.0001) |
Discharge against medical advice | 71 (0.4) | 94 (0.5) | 77 (0.4) | 96 (0.5) | 90 (0.4) | 80(0.4) | 80 (0.4) | 75 (0.4) | 115 (0.6) | 110 (0.5) | 175 (0.8) | 1,063 (0.5) | Increase (<0.0001) |
Mortality | 1,353 (7.6) | 1,470 (7.6) | 1,407 (7.3) | 1,329 (6.9) | 1,423 (6.9) | 1,320(7.0) | 1,290 (6.2) | 1,425 (7.0) | 1,400 (6.7) | 1,435 (6.9) | 1,345 (6.2) | 15,198 (6.9) | Decrease (<0.0001) |
Values are presented as number (%).
Trends of inpatient mortality for patients with colonic volvulus in the United States from 2007 to 2017
Outcome | Year |
Trend ( |
|||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2007–2017 | ||
Inpatient mortality | 1,353 (7.6) | 1,470 (7.6) | 1,407 (7.3) | 1,329 (6.9) | 1,423 (6.9) | 1,320 (7.0) | 1,290 (6.2) | 1,425 (7.0) | 1,400 (6.7) | 1,435 (6.9) | 1,345 (6.2) | 15,198 (6.9) | Decrease (<0.0001) |
Sex specific inpatient mortality | |||||||||||||
Male | 702 (9.0) | 704 (8.1) | 750 (8.7) | 629 (7.3) | 788 (8.7) | 675 (8.0) | 680 (7.5) | 800 (8.3) | 770 (8.0) | 815 (8.6) | 635 (6.5) | 7,948 (8.0) | Decrease (<0.0001) |
Female | 651 (6.5) | 766 (7.2) | 657 (6.1) | 700 (6.5) | 635 (5.5) | 645 (6.1) | 605 (5.2) | 625 (5.7) | 630 (5.5) | 620 (5.4) | 710 (6.0) | 7,245 (6.0) | Decrease (<0.0001) |
Race specific inpatient mortality | |||||||||||||
White | 775 (7.6) | 890 (7.3) | 954 (7.7) | 856 (6.6) | 975 (6.9) | 955 (7.2) | 920 (6.3) | 1,040 (7.2) | 950 (6.6) | 1,065 (7.2) | 975 (6.4) | 10,355 (6.7) | Decrease (<0.0001) |
Black | 130 (8.4) | 153 (8.0) | 164 (7.4) | 184 (7.4) | 185 (7.6) | 185 (7.5) | 175 (6.6) | 195 (6.8) | 230 (8.4) | 165 (5.8) | 195 (6.3) | 1,962 (7.2) | Decrease (0.0006) |
Hispanic | 86 (9.9) | 42 (4.6) | 100 (8.7) | 71 (6.3) | 108 (7.7) | 60 (5.5) | 55 (4.4) | 95 (8.1) | 105 (7.1) | 85 (6.9) | 80 (5.3) | 886 (6.7) | Decrease (0.0103) |
Age group specific inpatient mortality (yr) | |||||||||||||
18–34 | 30 (2.8) | 9 (0.7) | 14 (1.1) | 42 (3.2) | 28 (2.1) | 15 (1.2) | 25 (1.7) | 25 (2.0) | 25 (1.7) | 35 (2.7) | 25 (1.7) | 272 (1.9) | No trend (0.2937) |
35–49 | 33 (1.5) | 59 (2.4) | 52 (2.1) | 31 (1.4) | 40 (1.5) | 40 (1.7) | 30 (1.3) | 50 (2.1) | 50 (2.3) | 15 (0.7) | 40 (1.6) | 440 (1.7) | Decrease (0.0365) |
50–64 | 141 (3.9) | 210 (4.8) | 177 (4.1) | 175 (3.8) | 168 (3.3) | 160 (3.7) | 155 (3.3) | 230 (4.9) | 240 (4.8) | 240 (5.0) | 200 (4.0) | 2,096 (4.2) | Increase (0.0273) |
65–79 | 346 (6.2) | 339 (6.0) | 415 (7.2) | 362 (6.3) | 430 (7.2) | 385 (6.7) | 395 (6.2) | 375 (6.1) | 415 (6.4) | 495 (7.3) | 410 (5.9) | 4,366 (6.5) | No trend (0.4501) |
≥80 | 804 (14.9) | 853 (15.1) | 751 (13.4) | 720 (13.1) | 756 (13.3) | 720 (13.5) | 685 (12.1) | 745 (12.5) | 670 (11.5) | 650 (11.4) | 670 (11.4) | 8,023 (12.9) | Decrease (<0.0001) |
Length of stay (day) | 10.2 | 10.3 | 10.2 | 10.0 | 9.4 | 9.4 | 9.3 | 9.3 | 9.2 | 8.9 | 8.8 | 9.5 | Decrease (<0.0001) |
Total healthcare charge ($) | 64,447 | 71,134 | 76,499 | 80,922 | 82,287 | 80,755 | 86,498 | 90,470 | 95,968 | 98,523 | 100,928 | 84,968 | Increase (<0.0001) |
Values are presented as number (%).
Comparative analysis of endoscopic intervention and surgical intervention for colonic volvulus in the United States from 2007 to 2017
Variable | Management of colonic volvulus with endoscopic intervention | Management of colonic volvulus with surgical intervention | |
---|---|---|---|
Total no. of hospitalizations | 13,745 | 77,157 | |
Mean age (yr) | 66.3±0.14 | 70.1±0.33 | <0.0001 |
Age group (yr) | |||
18–34 | 632 (4.6) | 3,753 (4.9) | <0.0001 |
35–49 | 1,101 (8.0) | 8,674 (11.2) | <0.0001 |
50–64 | 2,667 (19.4) | 19,500 (25.3) | <0.0001 |
65–79 | 4,475 (32.6) | 25,694 (33.3) | <0.0001 |
≥80 | 4,870 (35.4) | 19,535 (25.3) | <0.0001 |
Sex | |||
Male | 7,623 (55.5) | 33,869 (43.9) | <0.0001 |
Female | 6,122 (44.5) | 43,264 (56.1) | <0.0001 |
Race | |||
White | 8,512 (68.3) | 54,920 (79.4) | <0.0001 |
Black | 2,288 (18.4) | 7,943 (11.5) | <0.0001 |
Hispanic | 1,005 (8.1) | 3,738 (5.4) | <0.0001 |
Asian | 298 (2.4) | 792 (1.1) | <0.0001 |
Native American | 31 (0.3) | 326 (0.5) | <0.0001 |
Other | 332 (2.7) | 1,480 (2.1) | <0.0001 |
Charlson comorbidity index | |||
0 | 4,734 (34.4) | 33,096 (42.9) | <0.0001 |
1 | 3,455 (25.1) | 18,452 (23.9) | <0.0001 |
2 | 2,531 (18.4) | 12,209 (15.8) | <0.0001 |
≥3 | 3,024 (22.0) | 13,399 (17.4) | <0.0001 |
Disposition | |||
Routine (home) | 6,500 (47.3) | 34,443 (44.7) | <0.0001 |
Transfer to short-term hospital | 348 (2.5) | 1,301 (1.7) | <0.0001 |
Transfer to another facility (skilled nursing facility, intermediate care facility) | 4,141 (30.1) | 23,782 (30.9) | <0.0001 |
Home health care | 1,804 (13.1) | 11,934 (15.5%) | <0.0001 |
Discharge against medical advice | 96 (0.7) | 177 (0.2%) | <0.0001 |
Inpatient mortality | 836 (6.1) | 5,396 (7.0%) | <0.0001 |
Sex specific inpatient mortality | |||
Male | 550 (7.2) | 3,041 (9.0) | 0.0285 |
Female | 286 (4.7) | 2,349 (5.4) | 0.2613 |
Race specific inpatient mortality | |||
White | 539 (6.3) | 3,730 (6.8) | 0.4799 |
Black | 125 (5.5) | 699 (8.8) | 0.0199 |
Hispanic | 65 (6.5) | 278 (7.5) | 0.6646 |
Age group specific inpatient mortality (yr) | |||
18–34 | 14 (2.3) | 103 (2.7) | 0.7559 |
35–49 | 10 (0.9) | 183 (2.1) | 0.2397 |
50–64 | 63 (2.4) | 834 (4.3) | 0.0340 |
65–79 | 248 (5.5) | 1,774 (6.9) | 0.1312 |
≥80 | 500 (10.3) | 2,501 (12.8) | 0.0313 |
Length of stay (day) | 8.3 | 11.8 | <0.0001 |
Total healthcare charge ($) | 68,126 | 106,703 | <0.0001 |
Values are presented as mean±standard error or number (%).
Comparative analysis of comorbidities associated with endoscopic intervention and surgical intervention for colonic volvulus in the United States from 2007 to 2017
Comorbidities | Management of colonic volvulus with endoscopic intervention ( |
Management of colonic volvulus with surgical intervention ( |
|
---|---|---|---|
Diabetes mellitus type 1 | 82 (0.6) | 502 (0.7) | 0.7338 |
Diabetes mellitus type 2 | 2,927 (21.3) | 10,389 (13.5) | <0.0001 |
Opioid use | 44 (0.3) | 369 (0.5) | 0.2437 |
Parkinson’s disease | 697 (5.1) | 2,418 (3.1) | <0.0001 |
Multiple sclerosis | 168 (1.2) | 748 (1.0) | 0.2207 |
Chronic constipation | 2,575 (18.7) | 8,765 (11.4) | <0.0001 |
Epilepsy | 959 (7.0) | 4,057 (5.3) | 0.0002 |
Anxiety | 837 (6.1) | 6,191 (8.0) | 0.0005 |
Depression | 524 (3.8) | 2,623 (3.4) | 0.2802 |
Migraines | 169 (1.2) | 1,105 (1.4) | 0.3860 |
Attention deficit hyperactivity disorder | 39 (0.3) | 337 (0.4) | 0.2461 |
Hypertension | 6,100 (44.4) | 30,716 (39.8) | <0.0001 |
Myocardial infarction | 243 (1.8) | 1,597 (2.1) | 0.3140 |
Cardiomyopathy | 429 (3.1) | 1,859 (2.4) | 4.9276 |
Congestive heart failure | 1,870 (13.6) | 8,710 (11.3) | 0.0006 |
Atrial fibrillation | 2,216 (16.1) | 11,101 (14.4) | 0.0185 |
Dyslipidemia | 2,929 (21.3) | 14,454 (18.7) | 0.0013 |
Anemia | 4,194 (30.5) | 23,807 (30.9) | 0.7336 |
Peripheral vascular disease | 567 (4.1) | 2,442 (3.2) | 0.0115 |
Chronic kidney disease | 1,563 (11.4) | 6,425 (8.3) | <0.0001 |
Acute kidney injury | 1,965 (14.3) | 12,460 (16.1) | 0.0130 |
Chronic obstructive pulmonary disease | 2,067 (15.0) | 9,963 (12.9) | 0.0029 |
Malnutrition | 1,509 (11.0) | 12,949 (16.8) | <0.0001 |
Obesity | 755 (5.5) | 3,712 (4.8) | 0.1313 |
Values are presented as number (%).
Predictors of inpatient mortality for management of colonic volvulus with endoscopic intervention in the United States from 2007 to 2017
Variable | Adjusted hazard ratio (95% confidence interval) | |
---|---|---|
Sex | ||
Male | Reference | |
Female | 0.585 (0.404–0.848) | 0.005 |
Race | ||
White | Reference | |
Black | 1.075 (0.657–1.759) | 0.774 |
Hispanic | 1.317 (0.703–2.467) | 0.390 |
Asian | 0.203 (0.026–1.585) | 0.128 |
Other | 1.001 (0.291–3.441) | 0.999 |
Charlson comorbidity index | 1.172 (1.096–1.254) | <0.0001 |
Hospital region | ||
Northeast | Reference | |
Midwest | 1.847 (1.098–3.109) | 0.021 |
South | 1.157 (0.754–1.776) | 0.503 |
West | 1.115 (0.654–1.903) | 0.689 |
Hospital bed size | ||
Small | Reference | |
Medium | 1.414 (0.802–2.493) | 0.231 |
Large | 1.479 (0.874–2.504) | 0.145 |
Hospital location and teaching status | ||
Rural | Reference | |
Urban nonteaching | 0.728 (0.375–1.411) | 0.347 |
Urban teaching | 1.075 (0.564–2.049) | 0.825 |
Comorbidities | ||
Without comorbidity | Reference | |
Type 2 diabetes mellitus | 0.992 (0.624–1.576) | 0.973 |
Parkinson’s disease | 1.256 (0.647–2.436) | 0.500 |
Chronic constipation | 0.533 (0.320–0.888) | 0.016 |
Epilepsy | 1.111 (0.454–2.721) | 0.817 |
Anxiety | 1.466 (0.599–3.589) | 0.402 |
Depression | 0.589 (0.196–1.772) | 0.346 |
Hypertension | 0.775 (0.542–1.107) | 0.161 |
Myocardial infarction | 2.688 (1.409–5.127) | 0.003 |
Cardiomyopathy | 1.324 (0.671–2.611) | 0.419 |
Congestive heart failure | 0.830 (0.554–1.243) | 0.365 |
Atrial fibrillation | 0.967 (0.657–1.424) | 0.866 |
Dyslipidemia | 0.959 (0.636–1.447) | 0.842 |
Anemia | 0.845 (0.584–1.224) | 0.374 |
Peripheral vascular disease | 1.104 (0.523–2.331) | 0.795 |
Chronic kidney disease | 0.386 (0.221–0.673) | 0.001 |
Acute kidney injury | 3.305 (2.303–4.743) | <0.0001 |
Chronic obstructive pulmonary disease | 1.242 (0.804–1.919) | 0.329 |
Malnutrition | 1.584 (1.022–2.456) | 0.040 |
Obesity (BMI >30 kg/m2) | 0.251 (0.034–1.872) | 0.177 |
BMI, body mass index.
Predictors of inpatient mortality for surgical management of colonic volvulus in the United States from 2007 to 2017
Variable | Adjusted hazard ratio (95% confidence interval) | |
---|---|---|
Sex | ||
Male | Reference | |
Female | 0.834 (0.730–0.953) | 0.008 |
Race | ||
White | Reference | |
Black | 1.195 (0.982–1.454) | 0.076 |
Hispanic | 1.212 (0.919–1.598) | 0.174 |
Asian | 1.299 (0.780–2.162) | 0.315 |
Other | 0.842 (0.520–1.363) | 0.483 |
Charlson comorbidity index | 1.169 (1.132–1.207) | <0.0001 |
Hospital region | ||
Northeast | Reference | |
Midwest | 0.913 (0.737–1.131) | 0.406 |
South | 1.189 (0.989–1.431) | 0.066 |
West | 0.874 (0.707–1.081) | 0.215 |
Hospital bed size | ||
Small | Reference | |
Medium | 1.268 (1.017–1.581) | 0.035 |
Large | 1.255 (1.016–1.551) | 0.035 |
Hospital location and teaching status | ||
Rural | Reference | |
Urban nonteaching | 1.037 (0.817–1.315) | 0.768 |
Urban teaching | 1.159 (0.911–1.474) | 0.231 |
Comorbidities | ||
Without comorbidity | Reference | |
Type 2 diabetes mellitus | 0.757 (0.624–0.918) | 0.005 |
Parkinson’s disease | 0.956 (0.708–1.291) | 0.767 |
Chronic constipation | 0.830 (0.656–1.051) | 0.122 |
Epilepsy | 2.128 (1.559–2.903) | <0.0001 |
Anxiety | 0.765 (0.528–1.109) | 0.157 |
Depression | 0.732 (0.429–1.251) | 0.254 |
Hypertension | 0.636 (0.551–0.734) | <0.0001 |
Myocardial infarction | 1.521 (1.179–1.962) | 0.001 |
Cardiomyopathy | 1.220 (0.910–1.637) | 0.184 |
Congestive heart failure | 0.873 (0.742–1.027) | 0.101 |
Atrial fibrillation | 0.975 (0.841–1.130) | 0.735 |
Dyslipidemia | 0.738 (0.627–0.869) | 0.0003 |
Anemia | 0.901 (0.787–1.031) | 0.131 |
Peripheral vascular disease | 0.954 (0.717–1.268) | 0.745 |
Chronic kidney disease | 0.431 (0.352–0.528) | <0.0001 |
Acute kidney injury | 3.496 (3.013–4.056) | <0.0001 |
Chronic obstructive pulmonary disease | 1.299 (1.110–1.520) | 0.001 |
Malnutrition | 1.204 (1.042–1.392) | 0.012 |
Obesity (BMI >30 kg/m2) | 1.564 (1.155–2.119) | 0.004 |
BMI, body mass index.