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The Impact of Bariatric Surgery on Diverticulitis Outcomes and Risk of Recurrent Hospitalizations in Adults with Clinically Severe Obesity

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Abstract

Purpose

Clinically severe obesity (SO) is a known risk factor for worsened outcomes and recurrence of acute diverticulitis. Paucity of data exist on outcomes of diverticulitis after bariatric surgery.

Methods

The Nationwide Readmissions Database was queried for diverticulitis hospitalizations between the years 2010 and 2014. We restricted analysis to patients with SO and those who had bariatric surgery (BRS). Outcomes of mortality, surgical events, and recurrent diverticulitis admissions were compared using multivariable analysis and one-to-one propensity score matching.

Results

Among 52,274 diverticulitis admissions, 91.2% (47,694) patients had SO and 8.8% (4580) had prior BRS. Patients with SO had higher odds of suffering mortality on index diverticulitis admission when compared to those with prior BRS [adjusted odds ratio (aOR): 10.55; 95%CI 1.45,76.75]. Patients with SO were also more likely to undergo emergency surgery (aOR: 1.71; 95%CI 1.25,2.34) and colectomy (aOR: 1.45; 95%CI 1.26,1.68). Rates of recurrent diverticulitis readmissions within 30 days and 6 months were also higher in patients with SO compared to BRS patients (aOR: 7.94; 95%CI 1.09,57.83 and aOR: 1.98; 95%CI 1.14,3.43, respectively). Propensity score matching confirmed our findings of increased rates of mortality (OR: 17.28; 95%CI 2.02,147.6), recurrent diverticulitis, and worsened surgical outcomes within 30 days in patients with SO compared to BRS.

Conclusion

This study is first to show improved outcomes and less recurrent hospitalizations for diverticulitis after bariatric surgery compared to patients with clinically severe obesity. Further studies are needed to understand mechanisms leading to this improvement and the role of weight loss in prevention of severe diverticulitis.

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Abbreviations

AOR:

Adjusted odds ratios

AHRQ:

Agency for Healthcare Research and Quality

BMI:

Body mass index

CI:

Confidence intervals

HCUP:

Healthcare Cost Utilization Project

ICU:

Intensive care unit

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

IQR:

Interquartile range

NRD:

Nationwide Readmission Database

OR:

Odds ratios

SE:

Standard error

SID:

State inpatient databases

SO:

Clinically severe obesity

US:

United States

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Funding

We did not rely on grant support or other assistance for this manuscript.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 2nd Floor, Columbus, Ohio, 43210, USA

    Kishan Patel, Somashekar G. Krishna, Darwin L. Conwell & Hisham Hussan

  2. Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, Ohio, 43210, USA

    Kyle Porter

  3. Department of Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, Ohio, 43210, USA

    Bradley J. Needleman & Stacy A. Brethauer

  4. The Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, Ohio, 43210, USA

    Darwin L. Conwell & Hisham Hussan

Authors
  1. Kishan Patel
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  2. Kyle Porter
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  3. Somashekar G. Krishna
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  4. Bradley J. Needleman
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  6. Darwin L. Conwell
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  7. Hisham Hussan
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Contributions

Dr. Patel was involved in the design, data interpretation, and drafting and critical revision of the manuscript. Mr. Porter was involved in the study’s design, acquiring and statistically analyzing the data, and critical revision of the manuscript. Drs. Krishna, Needleman, Brethauer, and Conwell were involved in the design, data interpretation, and critical revision of the manuscript. Dr. Hussan was involved in the conception, design, interpretation of data, and the manuscript’s drafting and critical revision.

Corresponding author

Correspondence to Hisham Hussan.

Ethics declarations

Ethics Statement

For this type of study formal consent is not required given that data contained within the NRD are neither identifiable nor private and thus do not meet the federal definition of ‘‘human subject’.’

Informed Consent

Informed consent does not apply.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Key Points

- Patients with prior bariatric surgery had improved outcomes in diverticulitis.

- These patients had less mortality, lower rates of surgery with less complications.

- These patients also had lower rates of recurrent diverticulitis admissions.

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Supplementary file1 (DOCX 28 KB)

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Patel, K., Porter, K., Krishna, S.G. et al. The Impact of Bariatric Surgery on Diverticulitis Outcomes and Risk of Recurrent Hospitalizations in Adults with Clinically Severe Obesity. OBES SURG 32, 365–373 (2022). https://doi.org/10.1007/s11695-021-05764-5

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  • DOI: https://doi.org/10.1007/s11695-021-05764-5

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