Ten-year management of acute colonic pseudo-obstruction in a single UK center: a retrospective cohort study.
Frailty score increase independently linked to higher odds of death in acute colonic pseudo-obstruction
Ten-year management of acute colonic pseudo-obstruction in a single UK center: a retrospective cohort study.
Acute colonic pseudo-obstruction (acute colonic pseudo-obstruction) is a rare but clinically significant cause of acute colonic dilatation without mechanical obstruction.
This study reports a 10-year experience of acute colonic pseudo-obstruction management at a large UK tertiary referral center and evaluates the relationship between frailty, treatment escalation, and mortality.
A retrospective cohort study identified adults with radiologically confirmed acute colonic pseudo-obstruction between January 2009 and March 2019.
each rise in frailty score independently raised odds of death
Forty-eight patients met the inclusion criteria (median age 81 years; 56.0% women), and 71.0% developed acute colonic pseudo-obstruction during hospitalization.
Surgery was required in 10.0% of cases, mainly due to perforation or ischemia.
Among patients aged ≥65 years with available frailty assessments, higher frailty was associated with increased 30-day mortality (44.0% with Clinical Frailty Scale ≥ 6 vs 8.0% with Clinical Frailty Scale < 6).
In the exploratory COVID-19 cohort ( n = 11), all patients received neostigmine, and none required surgery.
Higher frailty and greater cecal dilatation were associated with early mortality in patients with acute colonic pseudo-obstruction. Neostigmine use in routine practice appeared inconsistent outside highly monitored settings.
These observations suggest that a structured, frailty-informed management approach may support clinical decision-making; however, prospective studies are required to determine whether such pathways improve outcomes in older and multimorbid patients.