Skip to main content


Log in

Multi-institutional Cohort Study of Elective Diverticulitis Surgery: a National Surgical Quality Improvement Program Database Analysis to Identify Predictors of Non-home Discharge Among Older Adults

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery



Older adults often prioritize independence and time spent at home when making major treatment decisions. Identifying preoperative predictors of non-home discharge (i.e., requiring institutional discharge rather than home), among adults undergoing elective diverticulitis surgery, can support surgical decision-making and expectation management. This study aims to (1) examine rates of non-home discharge after elective surgery for diverticulitis and (2) identify predictors of non-home discharge.


This is a multi-institutional cohort study of National Surgical Quality Improvement Program Database. Patients over 18 years who underwent colon resection with diagnosis of diverticulitis were included. Clinical and demographic information were collected by trained nurse reviewers. Emergency operations were excluded. Patients with home versus non-home discharge were compared and predictors identified using multivariable regression.


Between 2016 and 2019, 40,912 patients were identified. Mean age was 58.5 years (SD = 12.58) with 48.5% 60 + years and 17.7% of patients 70 + years old. The majority (55.9%) were female and “White” race (83.5%). Most patients underwent colectomy without ostomy (88.4%). Nine percent of patients over age 60 had non-home discharge. Functional dependence preoperatively was strongly associated with non-home discharge. On multivariable analysis, significant predictors of non-home discharge were preoperative functional dependence (OR 28.2; 95% CI 9.8–81.7), advancing chronologic age (age 80 + : OR 22.4; 95% CI 18.6–26.9), and preoperative albumin < 3.0 (OR 4.0; 95% CI 3.4–4.6).


Nearly one in ten patients over 60 years was not discharged home after elective diverticulitis surgery. Preoperative functional status predicts non-home discharge. Future studies need to assess potentially modifiable causes of non-home discharge, such as social support.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Peery AF, Crockett SD, Barritt AS et al. Burden of Gastrointestinal, Liver, and Pancreatic Diseases in the United States. Gastroenterology. 2015;149(7):1731-1741.e3.

    Article  Google Scholar 

  2. Peery AF, Crockett SD, Murphy CC et al. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018. Gastroenterology. 2019;156(1):254-272.e11.

    Article  Google Scholar 

  3. Wheat CL, Strate LL. Trends in Hospitalization for Diverticulitis and Diverticular Bleeding in the United States From 2000 to 2010. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2016;14(1):96-103.e1.

    Google Scholar 

  4. Hall J, Hardiman K, Lee S et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum. 2020;63(6):728-747.

    Article  Google Scholar 

  5. Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med. 2007;357(20):2057-2066.

    Article  CAS  Google Scholar 

  6. Hamidi M, Joseph B. Changing Epidemiology of the American Population. Clin Geriatr Med. 2019;35(1):1-12.

    Article  Google Scholar 

  7. U.S. Department of Health & Human Services. Average length of stay for discharges from short-stay hospitals, by age and first-listed diagnosis: United States, 2010 [Discharges of inpatients from nonfederal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the. Published online 2010:26-27.

  8. Robinson TN, Rosenthal RA. The ACS NSQIP Geriatric Surgery Pilot Project: improving care for older surgical patients. Bull Am Coll Surg. 2014;99(10):21-23.

    PubMed  Google Scholar 

  9. Kwok AC, Semel ME, Lipsitz SR et al. The intensity and variation of surgical care at the end of life: A retrospective cohort study. Lancet. 2011;378(9800):1408-1413.

    Article  Google Scholar 

  10. Fried TR, Van Ness PH, Byers AL, Towle VR, O’Leary JR, Dubin JA. Changes in preferences for life-sustaining treatment among older persons with advanced illness. J Gen Intern Med. 2007;22(4):495-501.

    Article  Google Scholar 

  11. Pope A, Tarlov A. Toward a National Agenda For. The National Academies Press; 1991.

  12. Robinson TN, Wu DS, Stiegmann G V, Moss M. Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. Am J Surg. 2011;202(5):511-514.

    Article  Google Scholar 

  13. Makary MA, Segev DL, Pronovost PJ et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901-908.

    Article  Google Scholar 

  14. Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2009;48(1):78-83.

    Article  Google Scholar 

  15. Saxton A, Velanovich V. Preoperative frailty and quality of life as predictors of postoperative complications. Ann Surg. 2011;253(6):1223-1229.

    Article  Google Scholar 

  16. Kristjansson SR, Nesbakken A, Jordhøy MS et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol. 2010;76(3):208-217.

    Article  Google Scholar 

  17. Robinson TN, Eiseman B, Wallace JI et al. Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg. 2009;250(3):449-455.

    Article  Google Scholar 

  18. Lee KC, Sturgeon D, Lipsitz S, Weissman JS, Mitchell S, Cooper Z. Mortality and Health Care Utilization Among Medicare Patients Undergoing Emergency General Surgery vs Those With Acute Medical Conditions. JAMA Surg. 2020;155(3):216-223.

    Article  Google Scholar 

  19. Fried TR; Bradley EH, Towle VR AH. Understanding the Treatment Preferences of Seriously Ill Patients. N Engl J Med. 2002;346(14):1061-1066.

    Article  Google Scholar 

  20. Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg. 2009;250(3):363-376.

    Article  Google Scholar 

  21. Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data. J Am Coll Surg. 2018;226(2):173-181.e8.

    Article  Google Scholar 

  22. Bensken WP, Ho VP, Pieracci FM. Basic Introduction to Statistics in Medicine, Part 2: Comparing Data. Surg Infect (Larchmt). 2021;22(6):597-603.

    Article  Google Scholar 

  23. Lee PH, Burstyn I. Identification of confounder in epidemiologic data contaminated by measurement error in covariates. BMC Med Res Methodol. 2016;16:54.

    Article  Google Scholar 

  24. Lee PH. Should we adjust for a confounder if empirical and theoretical criteria yield contradictory results? A simulation study. Sci Rep. 2014;4:6085.

    Article  CAS  Google Scholar 

  25. Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35(5):526-529.

    Article  Google Scholar 

  26. Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014;311(20):2110-2120.

    Article  CAS  Google Scholar 

  27. Bilimoria KY, Liu Y, Paruch JL et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217(5):833.

    Article  Google Scholar 

  28. Sokas CM, Cowan J, Dalton MK et al. Association Between Patient-Reported Frailty and Non-Home Discharge Among Older Adults Undergoing Surgery. J Am Geriatr Soc. 2020;68(12):2909-2913.

    Article  Google Scholar 

  29. Lee DU, Fan GH, Hastie DJ et al. The clinical impact of malnutrition on the postoperative outcomes of patients undergoing colorectal resection surgery for colon or rectal cancer: Propensity score matched analysis of 2011-2017 US hospitals. Surg Oncol. 2021;38:101587.

    Article  Google Scholar 

  30. Bostock IC, Hill M V, Counihan TC, Ivatury SJ. Mortality after emergency Hartmann’s procedure in octogenarians: a propensity score-matched analysis. J Surg Res. 2018;221:167-172.

    Article  Google Scholar 

  31. Gillis C, Wischmeyer PE. Pre-operative nutrition and the elective surgical patient: why, how and what? Anaesthesia. 2019;74:27-35.

    Article  Google Scholar 

  32. Varghese BTK, Chishimba S, Ma M. The ACS Strong for Surgery program: Changing clinician and system behavior to optimize health before surgery | The Bulletin. Published online 2019:1–15.

  33. Gologorsky Y, Knightly JJ, Lu Y, Chi JH, Groff MW. Improving discharge data fidelity for use in large administrative databases. Neurosurg Focus. 2014;36(6):E2.

    Article  Google Scholar 

  34. Lee H, Shi SM, Kim DH. Home Time as a Patient-Centered Outcome in Administrative Claims Data. J Am Geriatr Soc. 2019;67(2):347-351.

    Article  Google Scholar 

Download references


The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Author information

Authors and Affiliations



CC, DC, SL, MB, ZC, and CR all made substantial contributions to conception and design of the work and interpretation of data, drafted the work critically for important intellectual content, approved the version to be published, and agreed to be accountable for all aspects of the work regarding accuracy or integrity.

Corresponding author

Correspondence to Christy E. Cauley.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



Table 4 Procedure and diagnosis codes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cauley, C.E., Chang, D.C., Lipsitz, S.R. et al. Multi-institutional Cohort Study of Elective Diverticulitis Surgery: a National Surgical Quality Improvement Program Database Analysis to Identify Predictors of Non-home Discharge Among Older Adults. J Gastrointest Surg 26, 1899–1908 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: