G. U. Anyanwu1, N. P. Omesiete1, M. Diri1, V. Nfonsam1 1University of Arizona,Surgery,Tucson, AZ, USA
Introduction:
The incidence of diverticulitis is on the rise in the last few decades. Uncomplicated diverticulitis could be treated with expectant management and at time surgical intervention. Complicated diverticulitis, however, could lead to significant morbidity and mortality in addition to major healthcare cost. The aim of this study is to assess the factors that contributes to an increased risk in developing complicated diverticulitis.
Methods:
A 10-year (2006-2016) retrospective analysis of all patients who underwent surgical intervention for diverticulitis using the NSQIP database was performed. The patients were subdivided to complicated and uncomplicated disease. Demographic factors included age, gender, and race/ethnicity. Additional factors analyzed included diabetes, obesity, COPD, smoking status, chronic steroid use, renal failure, Heart Failure, previous MI, previous cardiac surgery (PCS), and previous Percutaneous Coronary Intervention (PCI). A multi regression analysis was performed to determine the predictors for complicated diverticulitis.
Results:
.A total of 65,032 patients were analyzed; 56,919 with uncomplicated diverticulitis and 8,113 with complicated diverticulitis. Patients aged 70-80 (OR 1.42, p<0.0005), African Americans (OR 1.13, p<0.05) and patients with BMI≥30 (OR 1.10 p=0.0038) had a higher chance of developing complicated diverticulitis. Additionally, diabetes (OR 1.14, p<0.0005); especially if patients were not on insulin therapy (OR 1.24, p<0.005); COPD (OR 1.16, p<0.01), history of smoking (OR 1.29, p <0.0005), HF (OR 1.64, p=0.0001), ARF (OR 1.92, p<0.0005), CRF (OR 1.67, p<0.0005), and chronic steroid use (OR 1.68, p<0.0005) were predisposing factors for complicated diverticulitis. However, we found patients with PCS (OR 0.39, p<0.0005) and past PCI (OR 0.37, p<0.0005) had decreased odds of developing complicated diverticulitis.
Conclusion:
This study demonstrated that blacks, older patients, history of smoking, heart failure, diabetes, elevated BMI and acute/chronic renal failure are risk factors for complicated diverticulitis. These patients might benefit from closer monitoring prior to surgery and modifiable risked could be addressed