9.06 When Non-Operative Management for Acute Diverticulitis Fails: Using ACS-NSQIP for Outcomes Analysis

Posted on January 18, 2018

V. L. Luks1, J. Merola1, H. Dong2, F. Li2, K. Y. Pei1  1Yale School Of Medicine,Department Of Surgery,New Haven, CT, USA 2Yale School Of Medicine,Department Of Biostatistics,New Haven, CT, USA

INTRODUCTION

Management of uncomplicated acute diverticulitis is largely non-operative; however, some patients will require surgery during the same hospital stay. Lacking clear guidelines delineating optimal surgical approach and operative timing in this patient population, these decisions are left to the surgeon’s discretion. There is no information regarding the effect of timing of surgery on surgical site infections, length of stay, and mortality.  The objective of this study was to evaluate the association between time to operation with outcomes of interest in patients who underwent colectomy for acute diverticulitis.

 

METHODS

The 2011-2015 ACS-NSQIP database was examined for patients with diverticulitis who underwent urgent (non elective and non emergent) open or laparoscopic colectomy. Outcomes of interest were analyzed using multivariate logistic regression adjusting for patient characteristics and wound classification (surrogate for Hinchey classification). The primary outcomes of interest were: superficial surgical site, deep incisional, or organ space infection or a wound disruption. Secondary outcomes included post-operative length of stay (LOS) greater than 14 days and in hospital mortality.

 

RESULTS

Among patients with diverticulitis who required urgent surgery, 1,576 underwent laparoscopic and 3,571 underwent open colectomy. Waiting beyond 3 days to operate  was associated with greater risk for post-operative infectious complications (OR=1.24, 95%CI=1.03-1.48, p=0.02, and prolonged post-operative length of stay > 14 days (OR=1.76, 95%CI=1.42-2.19, p<0.01); there was no increased risk of post-operative mortality (OR=1.53, 95%CI=0.94-2.49, p=0.08).

 

CONCLUSION

For patients who do not improve clinically during a trial of non-operative management, waiting beyond 3 days after presentation is associated with worse outcomes following open colectomy among surgical candidates presenting with acute diverticulitis.