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Su1737 Interval Sigmoidectomy After Rigid Sigmoidoscope Reduction - A Safe Operation
Patient Characteristics by Genetic Status
Table 1: Reasons of unplanned readmission after appendectomy (NSQIP 2012)
Su1737 Interval Sigmoidectomy After Rigid Sigmoidoscope Reduction - A Safe Operation Ajit Ronald G. Singh BACKGROUND Sigmoid volvulus is one of the most common cause of large bowel obstruction in the Indian sub continent, especially in the eastern region of India. It accounts for nearly 50% of all large bowel obstruction. METHOD The record of 170 patients were reviewed who were operated in the past 12 years with sigmoid volvulus. FINDING The mean age was 41.9 years (6- 85years) and 88 patients were females(52%). Abdominal distention (99%) and constipation (91.2%) were the most common symptoms, while (70.6%) had pain, (30.2%) vomiting ,(8.8%) had fever and (23.6%) patients had recurrent episodes of volvulus. Duration of symptoms ranged from 1-30 days. Sigmoidoscopic reduction of volvulus with rigid sigmoidoscope and flatus tube was done in 107(63%) patients, 63 of whom underwent open interval sigmoid colectomy . RESULTS No mortality following sigmoidoscopic reduction of volvulus in 107 patients. No mortality in the group where interval sigmoidectomy was performed in 63 patients. Conclusion Interval sigmoid colectomy is a safe operation with minimal morbidity/mortality. Sigmoidoscopic reduction of volvulus is a safe,quick non operative intervention which can be applied to all clinically/ radialogically suspected sigmoid volvulus without gangrene or perforation. This procedure can be performed safely in rural health care centres.
SSAT Abstracts
All p<0.0001
Su1738 Endoscopy Through Colostomy: A Population-Based Study Nicole E. Wieghard, Vassiliki L. Tsikitis Background: Endoscopic evaluation of the colon is a critical tool for screening and surveillance for colorectal diseases. Little is known about the use of colonoscopy in patients with colostomies, nearly all of whom have antecedent colon disease. Objective: The objective of this study is to describe the indications and outcomes for colonoscopy through colostomies. Methods: Retrospective review of colonoscopies through colostomies was performed from 2000 - 2013. Data were obtained from the National Endoscopic Database of Clinical Outcomes Research Initiative, and included procedures from 86 contributing GI practices. Main outcomes measures were primary indication, quality of bowel prep, procedure duration, polyp detection rate and procedural complications. Colonoscopies through the anus for the same time period were used as a reference group. Results: A total of 3,801 colonoscopies were performed through colostomies (stoma group) and 1,496,614 colonoscopies were performed through the anus (no-stoma group). Patients in the stoma group were more likely to be older (mean 64 vs 60, p <0.0001) and male (60% vs 52%, p <0.0001) than the nostoma group. Surveillance was the most common indication in the stoma group (49% vs 17%, p < 0.0001), whereas screening was the most common for the no-stoma group (26% vs 6%, p <0.0001). Abdominal pain, changes in bowel habits, and bleeding were more common indications for the no-stoma group (33.5% vs 29.4%, p <0.0001). IBD evaluation/ surveillance was infrequent as an indication but higher in stoma group (6.2% vs 2.2%, p < 0.0001). Bowel prep quality was excellent or good in 59.5% of procedures in the stoma group and 69.1% in no-stoma group (p < 0.0001). Cecal intubation rate was lower in the stoma group (93.3% vs 96%, p < 0.0001). Procedure duration in minutes was similar among the cohorts (22.2 in stoma, 22.8 in no-stoma, p = 0.03). Polyp detection rates were higher in the no-stoma group (42.6% vs 31%, p <0.0001). Complication rates were low (0.63% in stoma vs 1.12% no-stoma, p = 0.004). There were no differences in complications requiring intervention (0.16% stoma group vs 0.26% no-stoma, p = 0.2). Conclusion: Patients with colostomies represent a high risk group as they are often undergoing colonoscopies for colorectal cancer surveillance. There is a need for improved quality control of colonoscopies in this patient group, as cecal intubation rates, adequate bowel preps, and polyp detection rates are all significantly lower than patients without colostomies and lower than current quality assurance goals.
Su1736 Unplanned Readmission After Appendectomy Zhobin Moghadamyeghaneh, Mark H. Hanna, Joseph C. Carmichael, Steven Mills, Alessio Pigazzi, Michael J. Stamos Background Unplanned readmission of patients who undergo appendectomy is a relatively frequent occurrence, particularly considering the size of the overall patient population. We sought to report the incidence, most common reasons, and predictors of unplanned readmission within 30 days of operation following appendectomy. Method The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was used to examine the clinical data of patients undergoing emergent/urgent appendectomy with a diagnosis of acute appendicitis in 2012. Multivariate regression analysis was performed to identify the predictors of unplanned readmission. Results We evaluated 15,394 patients who underwent appendectomy. Of these, 2754 (17.9%) of patients had perforated appendicitis. Overall, 539 (3.5%) of patients had an unplanned readmission. The most common indication for unplanned readmission was intra-abdominal infection (36.7%), nonspecific pain (5.5%) and paralytic ileus (5%). With multivariate analysis, the most important predictor of unplanned readmission was pregnancy (AOR: 5.02, P<0.01) followed by chronic pulmonary disease (COPD) (AOR: 3.14, P=0.01), diabetes (AOR: 2.25, P<0.01), and preoperative sepsis (AOR: 1.60, P<0.01). Patients who were hospitalized more than two days had a higher risk of unplanned readmission (AOR: 1.63, P=0.03). Patients with perforation had a significantly higher risk of unplanned readmission compared to patients without perforation and complications (peritonitis or abscess) (AOR: 1.64, p=0.02). Conclusion Overall, 3.5% of patients who underwent emergent appendectomy had an unplanned readmission to the hospital within 30 days of operation. Pregnant patients have the highest risk of postoperative readmission. Also, patients with preoperative sepsis, SIRS, septic shock or comorbidities of COPD and diabetes have increased risk of postoperative readmission. Importantly, perforated appendicitis increases the risk of unplanned readmission to hospital. Intra-abdominal infections followed by nonspecific pain and paralytic ileus are the most common reasons for readmission.
SSAT Abstracts
S-1134
Table 1: Reasons of unplanned readmission after appendectomy (NSQIP 2012)
Su1737 Interval Sigmoidectomy After Rigid Sigmoidoscope Reduction - A Safe Operation Ajit Ronald G. Singh BACKGROUND Sigmoid volvulus is one of the most common cause of large bowel obstruction in the Indian sub continent, especially in the eastern region of India. It accounts for nearly 50% of all large bowel obstruction. METHOD The record of 170 patients were reviewed who were operated in the past 12 years with sigmoid volvulus. FINDING The mean age was 41.9 years (6- 85years) and 88 patients were females(52%). Abdominal distention (99%) and constipation (91.2%) were the most common symptoms, while (70.6%) had pain, (30.2%) vomiting ,(8.8%) had fever and (23.6%) patients had recurrent episodes of volvulus. Duration of symptoms ranged from 1-30 days. Sigmoidoscopic reduction of volvulus with rigid sigmoidoscope and flatus tube was done in 107(63%) patients, 63 of whom underwent open interval sigmoid colectomy . RESULTS No mortality following sigmoidoscopic reduction of volvulus in 107 patients. No mortality in the group where interval sigmoidectomy was performed in 63 patients. Conclusion Interval sigmoid colectomy is a safe operation with minimal morbidity/mortality. Sigmoidoscopic reduction of volvulus is a safe,quick non operative intervention which can be applied to all clinically/ radialogically suspected sigmoid volvulus without gangrene or perforation. This procedure can be performed safely in rural health care centres.
SSAT Abstracts
All p<0.0001
Su1738 Endoscopy Through Colostomy: A Population-Based Study Nicole E. Wieghard, Vassiliki L. Tsikitis Background: Endoscopic evaluation of the colon is a critical tool for screening and surveillance for colorectal diseases. Little is known about the use of colonoscopy in patients with colostomies, nearly all of whom have antecedent colon disease. Objective: The objective of this study is to describe the indications and outcomes for colonoscopy through colostomies. Methods: Retrospective review of colonoscopies through colostomies was performed from 2000 - 2013. Data were obtained from the National Endoscopic Database of Clinical Outcomes Research Initiative, and included procedures from 86 contributing GI practices. Main outcomes measures were primary indication, quality of bowel prep, procedure duration, polyp detection rate and procedural complications. Colonoscopies through the anus for the same time period were used as a reference group. Results: A total of 3,801 colonoscopies were performed through colostomies (stoma group) and 1,496,614 colonoscopies were performed through the anus (no-stoma group). Patients in the stoma group were more likely to be older (mean 64 vs 60, p <0.0001) and male (60% vs 52%, p <0.0001) than the nostoma group. Surveillance was the most common indication in the stoma group (49% vs 17%, p < 0.0001), whereas screening was the most common for the no-stoma group (26% vs 6%, p <0.0001). Abdominal pain, changes in bowel habits, and bleeding were more common indications for the no-stoma group (33.5% vs 29.4%, p <0.0001). IBD evaluation/ surveillance was infrequent as an indication but higher in stoma group (6.2% vs 2.2%, p < 0.0001). Bowel prep quality was excellent or good in 59.5% of procedures in the stoma group and 69.1% in no-stoma group (p < 0.0001). Cecal intubation rate was lower in the stoma group (93.3% vs 96%, p < 0.0001). Procedure duration in minutes was similar among the cohorts (22.2 in stoma, 22.8 in no-stoma, p = 0.03). Polyp detection rates were higher in the no-stoma group (42.6% vs 31%, p <0.0001). Complication rates were low (0.63% in stoma vs 1.12% no-stoma, p = 0.004). There were no differences in complications requiring intervention (0.16% stoma group vs 0.26% no-stoma, p = 0.2). Conclusion: Patients with colostomies represent a high risk group as they are often undergoing colonoscopies for colorectal cancer surveillance. There is a need for improved quality control of colonoscopies in this patient group, as cecal intubation rates, adequate bowel preps, and polyp detection rates are all significantly lower than patients without colostomies and lower than current quality assurance goals.
Su1736 Unplanned Readmission After Appendectomy Zhobin Moghadamyeghaneh, Mark H. Hanna, Joseph C. Carmichael, Steven Mills, Alessio Pigazzi, Michael J. Stamos Background Unplanned readmission of patients who undergo appendectomy is a relatively frequent occurrence, particularly considering the size of the overall patient population. We sought to report the incidence, most common reasons, and predictors of unplanned readmission within 30 days of operation following appendectomy. Method The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was used to examine the clinical data of patients undergoing emergent/urgent appendectomy with a diagnosis of acute appendicitis in 2012. Multivariate regression analysis was performed to identify the predictors of unplanned readmission. Results We evaluated 15,394 patients who underwent appendectomy. Of these, 2754 (17.9%) of patients had perforated appendicitis. Overall, 539 (3.5%) of patients had an unplanned readmission. The most common indication for unplanned readmission was intra-abdominal infection (36.7%), nonspecific pain (5.5%) and paralytic ileus (5%). With multivariate analysis, the most important predictor of unplanned readmission was pregnancy (AOR: 5.02, P<0.01) followed by chronic pulmonary disease (COPD) (AOR: 3.14, P=0.01), diabetes (AOR: 2.25, P<0.01), and preoperative sepsis (AOR: 1.60, P<0.01). Patients who were hospitalized more than two days had a higher risk of unplanned readmission (AOR: 1.63, P=0.03). Patients with perforation had a significantly higher risk of unplanned readmission compared to patients without perforation and complications (peritonitis or abscess) (AOR: 1.64, p=0.02). Conclusion Overall, 3.5% of patients who underwent emergent appendectomy had an unplanned readmission to the hospital within 30 days of operation. Pregnant patients have the highest risk of postoperative readmission. Also, patients with preoperative sepsis, SIRS, septic shock or comorbidities of COPD and diabetes have increased risk of postoperative readmission. Importantly, perforated appendicitis increases the risk of unplanned readmission to hospital. Intra-abdominal infections followed by nonspecific pain and paralytic ileus are the most common reasons for readmission.
SSAT Abstracts
S-1134