L. Durbak1, G. D. Kennedy1, E. H. Carchman1 1University Of Wisconsin,School Of Medicine And Public Health,Madison, WI, USA
Introduction: The risk of developing diverticulosis by the age of 80 is virtually 100%. Up to 20% of individuals with diverticulosis will require hospitalization with 20-50% of these patients requiring operative intervention, resulting in an estimated annual cost of $2.6 billion. This study aims to examine the postoperative outcomes in the setting of emergent surgical management of diverticulitis, and then try to examine if these changes correlated with changes in surgical practice.
Methods: Data was obtained from the ACS NSQIP PUFs from 2005 to 2013. Inclusion criteria were patients undergoing emer-gency surgery with a post-operative diagnosis of diverticula of the colon or diverticulitis with or without mention of hemorrhage. Multivariate regression models were developed using trends in pre-, intra- and postoperative variables identified through univariate analyses. The impact of practice variables were analyzed using multivariate regression models, adjusting for biases in surgical approach due to preoperative patient factors by including propensity scores for each practice variable.
Results:Preoperative comorbidities dyspnea, dependent functional status, ascites and >10% weight loss significantly decreased over the study period. Intraoperative variables ASA class 2 and clean/contaminated wound class significantly decreased over the study period. ASA class 3 and the dirty/infected wound class increased. Of the postoperative variables considered, length of stay, ventilator dependency, and renal insufficiency decreased while organ space surgical site infection and sepsis increased. Multivariate analyses of pre- and intraoperative variable as explanatory factors of postoperative complications suggested several significant relationships, notably ascites and dyspnea with worse outcomes and ASA classes 2 and 3 with better outcomes. The odds ratios for laparoscopy and stoma creation over time were statistically significant but very close to 1 (95% CI between 1.00-1.09).Laparoscopy was significantly associated with decreased odds of several surgical complications, regardless of propensity score adjustment. The stoma creation variable was associated with increased odds of surgical complications, but these associations disappeared after propensity score adjustment. The drain placement variable was only significantly associated with an increased odds of sepsis.
Conclusion: In conclusion, this analysis suggests that a lack of substantial change in surgical practices for patients presenting with diverticulitis in the emergency setting is associated with a lack of consistent improvement in patient outcomes. This research adds to the existing evidence of the benefits of laparoscopic management of diverticulitis in the emergency setting.
