A. Mehta1, J. K. Canner2, D. T. Efron2, J. Efron2, J. V. Sakran2 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA
Introduction: Diverticulitis remains a common problem for patients with diverticular disease. This study compared outcomes between elective and emergent bowel resections for diverticulitis.
Methods: We used the 2005-2011 California State Inpatient Database to identify patients who had elective or emergent large bowel resections for diverticulitis (without hemorrhage). Primary outcomes included in-hospital mortality, complications, and extended length of stay (LOS, defined as >8 days). Secondary outcomes included 30-day inpatient readmissions and predictors of emergent repairs. Analyses adjusted for clinical factors and accounted for hospital clusters.
Results: We identified 28,813 patients undergoing large bowel resections for diverticulitis (2.0% mortality rate, 17.0% complication rate, and 22.6% extended LOS rate). Among all resections, one-third (31.8%) were performed emergently and one-quarter (23.2%) included a colostomy (6.1% of elective, 60.0% of emergent). Of the 911 patients with inpatient readmissions within 30 days of discharge, 211 (23.2%) presented to a different hospital. After multivariable logistic regression, emergent resections relative to elective resections were associated with significantly higher odds of death (aOR 2.85 [95%-CI 2.16-3.76]), complications (2.01 [1.85-2.18]), and extended LOS (1.75 [1.61-1.92]) (Figure). Emergent resections were also trending towards both greater 30-day readmissions (1.19 [0.96-1.46], P=0.08) and being readmitted to a different hospital (1.45 [0.96-2.18], P=0.07). Hispanic (1.19 [1.11-1.27]), self-pay (3.68 [3.62-4.08]), and Medicaid patients (1.19 [1.08-1.30]) were associated with emergent repairs.
Conclusion: One-third of patients undergoing surgical management for diverticulitis had emergent bowel resections, which were associated with worse postoperative outcomes and were trending towards increased 30-day readmissions. Additionally, a quarter of readmitted patients presented to a different hospital and differences in surgical care existed by race and payer.
