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Outcomes of diverticulitis in patients with tobacco smoking: a propensity-matched analysis of nationwide inpatient sample

  • Original Article
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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Recent data shows a significantly increased risk of diverticulosis among smokers. There is limited data on the association between tobacco smoking and diverticulitis. We aim to determine in-hospital outcomes, length of hospital stay, and resource utilization in a contemporary cohort of diverticulitis patients based on tobacco smoking status.

Methods

A retrospective analysis was performed by utilizing the National Inpatient Sample database (2016 and 2017) and the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of diverticulitis and smoking. We assessed all-cause in-hospital mortality, morbidity, length of hospital stay (LOS), and total costs between propensity-matched groups of tobacco smokers vs. nonsmokers with diverticulitis.

Results

We identified 442,273 diverticulitis patients, of whom 96,864 were tobacco smokers, and 345,409 were nonsmokers. Between the two groups, in-hospital mortality was not significant (OR 1.09, 95% CI 0.38–2.6; P = 0.98). Tobacco smokers with diverticulitis have higher odds of lower gastrointestinal bleeding (LGIB) (OR 1.6, 95% CI 1.4–3.8; P = 0.01), peritonitis (OR 1.5, 95% CI 1.9–3.3; P = 0.00), intestinal obstruction (OR 1.6, 95% CI 2.8–7.6; P = 0.00), sepsis (OR 2.1, 95% CI 1.05–4.4; P = 0.03), and shock requiring vasopressor (OR 1.5, 95% CI 1.2–2.2; P = 0.00). In tobacco smokers with complicated diverticulitis, there were higher odds of LGIB (OR 1.4, 95% CI 1.2–1.6; P = 0.00), sepsis (OR 2.1, 95% CI 1.05–4.4; P = 0.03), and colectomy (OR 1.2, 95% CI 1.1–1.2; P = 0.00). In-hospital mortality was not significant in smokers with complicated diverticulitis (OR 1.2, 95% CI 0.78–1.9; P = 0.3).

Conclusions

In this propensity-matched analysis, there was no difference in in-hospital mortality between tobacco smokers vs. nonsmokers with diverticulitis. Smoking has been associated with an increased incidence of complications in diverticulitis with a higher length of hospital stay and resource utilization.

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Authors and Affiliations

  1. Department of Medicine, Interfaith Medical Center, 1545, Atlantic Avenue, Brooklyn, NY, 11238, USA

    Vijay Gayam, Soniya Koirala & Pavani Reddy Garlapati

  2. SUNY Downstate University Hospital, Syracuse, NY, USA

    Vijay Gayam

  3. American University of Antigua, Osbourn, Antigua and Barbuda

    Vijay Gayam

  4. Eastern Section, American Federation for Medical Research, Beverly, MA, USA

    Vijay Gayam

  5. Department of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, USA

    Amrendra Kumar Mandal

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Contributions

Dr. Gayam proposed the concept, designed the study, wrote the protocol, and managed the study. Dr. Koirala, Dr. Garlapati, and Dr. Gayam interpreted the data and wrote the manuscript. Dr. Gayam performed the statistics. All authors provided inputs for revision of the manuscript. Dr. Mandal provided a critical review. Dr. Gayam communicated with the journal and addressed comments from reviewers. All the authors vouch for the veracity and completeness of the data presented and agreed to submit the manuscript for publication.

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Correspondence to Vijay Gayam.

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Our study was exempt from approval from the Institutional Review Board, given the deidentified nature of the National inpatient database.

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Gayam, V., Koirala, S., Garlapati, P.R. et al. Outcomes of diverticulitis in patients with tobacco smoking: a propensity-matched analysis of nationwide inpatient sample. Int J Colorectal Dis 36, 1033–1042 (2021). https://doi.org/10.1007/s00384-020-03805-6

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