N. Bartschat1, D. Thompson2, C. Tran2, J. Hrabe1, K. Guyton1, P. Goffredo2, I. Hassan1 1University Of Iowa, Department Of Surgery, Iowa City, IA, USA 2University Of Minnesota, Department Of Surgery, Minneapolis, MN, USA
Introduction:
Epidemiological studies have observed that patients with severe obesity (BMI > 40 kg/m2) are more likely to develop symptomatic diverticular disease compared to patients without obesity (BMI < 30 kg/m2). A proportion of these patients will require emergent surgery due to complications of diverticulitis.
We hypothesized that patients with severe obesity would have higher rates of adjusted 30-day morbidity and mortality following emergency colectomy for diverticular disease.
Methods:
We utilized the American College of Surgeons National Surgical Quality Improvement Program database to assess the incidence of postoperative morbidity in patients with severe obesity undergoing emergent colectomy for diverticulitis between 2015 and 2021, comparing their outcomes to patients without obesity.
Patient demographics and perioperative outcomes data were collected and analyzed. Major and minor complication rates were assessed by the Clavien-Dindo classification.
Multivariable logistic regression was performed to identify risk factors independently associated with postoperative morbidity in the study population.
Results:
We identified 1,747 patients with BMI > 40 kg/m2 and 12,227 patients with BMI < 30 kg/m2.
Patients with severe obesity undergoing emergent surgery were younger (median age 54 vs 65 years, P<0.001) and had a higher proportion of ASA III/IV (84% vs 65%). Rates of laparoscopic surgery were similar between the two groups at 21% in each.
There was a higher incidence of Clavien-Dindo I/II (minor) (43% vs 37%, P<0.001), Clavien-Dindo III/IV (major) (10% vs 6%, P<0.001) complications (Table 1) and readmission rates (13% vs 10%, P<0.01) in patients with severe obesity compared to patients without obesity.
Patients with severe obesity had a higher incidence of infectious complications including superficial incisional infection (7% vs 5%, P<0.001), deep incisional infection (3% vs 1%, P<0.001), organ space infection (14% vs 12%, P<0.05), sepsis (23% vs 19%, P<0.001), and septic shock (14% vs 9%, P<0.001).
After adjusting for available confounders, age greater than 65 years, male sex, and history of congestive heart failure (CHF) were independent predictors of postoperative complications among patients with severe obesity.
The 30-day mortality rate was 5% and was similar between the groups.
Conclusion:
Patients with severe obesity undergoing emergent surgery for diverticular disease were at a higher risk of perioperative morbidity, but not mortality. Risk of an adverse outcome was associated with male gender, advanced age, and comorbidities such as CHF. This data may help facilitate the informed consent process in patients with severe obesity preoperatively.