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Proximal Intestinal Diversion is Associated with Increased Morbidity in Patients Undergoing Elective Colectomy for Diverticular Disease: An ACS-NSQIP Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Elective colectomy for diverticular disease is common. Some patients undergo primary resection with proximal diversion in an effort to limit morbidity associated with potential anastomotic leak.

Methods

The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried. All patients undergoing a single, elective resection for diverticular disease from 2005 to 2011 were analyzed. Thirty-day outcomes were reviewed. Factors predictive of undergoing diversion and the risk-adjusted odds of postoperative morbidity with and without proximal diversion were determined by multivariable logistic regression models.

Results

Fifteen thousand six hundred two patients undergoing non-emergent, elective resection were identified, of whom 348 (2.2 %) underwent proximal diversion. Variables predictive for undergoing proximal diversion included age ≥65 years, BMI ≥30, current smoking status, corticosteroid use, and serum albumin <3.0 g/dL. Multivariable analysis demonstrated that diversion was associated with significantly increased risk of surgical site infection (OR = 1.68), deep venous thrombosis (OR = 5.27), acute renal failure (OR = 5.83), sepsis or septic shock (OR = 1.75), readmission (OR = 2.57), and prolonged length of stay (OR = 3.35).

Conclusions

Proximal diversion in the setting of elective segmental colectomy for diverticular disease is uncommon. A combination of preoperative factors and intraoperative factors drives the decision for diversion. Patients who undergo diversion experience increased postoperative morbidity. Surgeons should have a low index of suspicion for postoperative complications and be prepared to mitigate their effect on the patient’s outcome.

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Acknowledgments

We would like to acknowledge Sharon Nehring for her contribution to this study.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Kevin B. Wise & Elizabeth B. Habermann

  2. Section of Colon & Rectal Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Amit Merchea & Dorin T. Colibaseanu

  3. Division of Colon & Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    Robert R. Cima

  4. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Robert R. Cima, Kristine M. Thomsen & Elizabeth B. Habermann

Authors
  1. Kevin B. Wise
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  2. Amit Merchea
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  3. Robert R. Cima
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  4. Dorin T. Colibaseanu
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  5. Kristine M. Thomsen
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  6. Elizabeth B. Habermann
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Correspondence to Amit Merchea.

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Wise, K.B., Merchea, A., Cima, R.R. et al. Proximal Intestinal Diversion is Associated with Increased Morbidity in Patients Undergoing Elective Colectomy for Diverticular Disease: An ACS-NSQIP Study. J Gastrointest Surg 19, 535–542 (2015). https://doi.org/10.1007/s11605-014-2700-4

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  • DOI: https://doi.org/10.1007/s11605-014-2700-4

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