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Post-operative morbidity, but not mortality, is worsened by operative delay in septic diverticulitis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Optimal timing of surgery for acute diverticulitis remains unclear. A non-operative approach followed by elective surgery 6-week post-resolution is favored. However, a subset of patients fail on the non-operative management during index admission. Here, we examine patients requiring emergent operation to evaluate the effect of surgical delay on patient outcomes.

Methods

Patients undergoing emergent operative intervention for acute diverticulitis were queried using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2012. Primary endpoints of 30-day overall morbidity and mortality were evaluated via univariate and multivariate analysis.

Results

Of the 2,119 patients identified for study inclusion, 57.2 % (n = 1212) underwent emergent operative intervention within 24 h, 26.3 % (n = 558) between days 1–3, 12.9 % (n = 273) between days 3–7, and 3.6 % (n = 76) greater than 7 days from admission. End colostomy was performed in 77.4 % (n = 1,640) of cases. Unadjusted age and presence of major comorbidities increased with operative delay. Further, unadjusted 30-day overall morbidity, mortality, septic complications, and post-operative length of stay increased significantly with operative delay. On multivariate analysis, operative delay was not associated with increased 30-day mortality but was associated with increased 30-day overall morbidity.

Conclusions

Hartmann’s procedure has remained the standard operation in emergent surgical management of acute diverticulitis. Delay in definitive surgical therapy greater than 24 h from admission is associated with higher rates of morbidity and protracted post-operative length of stay, but there is no increase in 30-day mortality. Prospective study is necessary to further answer the question of surgical timing in acute diverticulitis.

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Authors’ contributions

Kasten had full access to all data and takes responsibility for the integrity and accuracy of data analysis.

Acquisition of data: Kasten.

Analysis and interpretation of data: Mozer, Sippey, Celio, Spaniolas, and Kasten.

Drafting of the manuscript: Mozer, Spaniolas, and Kasten.

Critical revision of the manuscript for important intellectual content: Mozer, Sippey, Celio, Spaniolas, Manwaring, and Kasten.

Statistical analysis: Sippey, Spaniolas, and Kasten.

Study supervision: Kasten.

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Authors and Affiliations

  1. Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd, 2MA234, Greenville, NC, 27834, USA

    Anthony B. Mozer, Konstantinos Spaniolas, Megan E. Sippey, Adam Celio, Mark L. Manwaring & Kevin R. Kasten

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  1. Anthony B. Mozer
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  2. Konstantinos Spaniolas
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  3. Megan E. Sippey
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  4. Adam Celio
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Correspondence to Kevin R. Kasten.

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The authors declare that they have no conflict of interest.

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The study has been approved by all authors in the present format.

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Mozer, A.B., Spaniolas, K., Sippey, M.E. et al. Post-operative morbidity, but not mortality, is worsened by operative delay in septic diverticulitis. Int J Colorectal Dis 32, 193–199 (2017). https://doi.org/10.1007/s00384-016-2689-0

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  • DOI: https://doi.org/10.1007/s00384-016-2689-0

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