Skip to main content

Advertisement

SpringerLink
Log in

Delay to Intervention for Complicated Diverticulitis is Associated with Higher Inpatient Mortality

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Patients with diverticular disease complicated by abscess and/or perforation represent the most severely afflicted with the highest mortality and poorest outcomes. This study investigated patient and operative factors associated with poor outcomes from diverticulitis complicated by abscess or perforation.

Methods

We analyzed the National Inpatient Sample to identify inpatient discharges for colonic diverticulitis in the United States from 1/1988 to 9/2015. We identified patients with perforation and/or intestinal abscess based on ICD-9 codes. The primary outcome was inpatient mortality.

Results

During the study period, a total of 993,220 patients were discharged with diverticulitis from sampled U.S. hospitals. From this group, 10.7% had an abscess and 1.0% had a perforation associated with diverticular disease. Inpatient mortality of diverticulitis patients with a perforation was 5.4% compared to 1.5% in those without a perforation (p<0.001). Patients with a perforation who underwent surgery had an inpatient mortality of 6.3% vs. 3.0% mortality amongst patients with a perforation who did not undergo an operation (p<0.001). Patients with a perforation that underwent surgery had a 31% increased mortality risk for each day after admission that a procedure was delayed (OR 1.31, CI 1.05–1.78; p=0.03). Mortality risk was increased for patients with either abscess or perforation who underwent surgery if they were female, age ≥65, higher comorbidity, were admitted urgently, underwent peritoneal lavage, or had a post-procedural complication.

Conclusions

Patients with perforated diverticular disease had substantial associated inpatient mortality compared to those with uncomplicated diverticulitis. This increased risk may be associated with performance of peritoneal lavage or because of a delay to procedural intervention.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kozak LJ, DeFrances CJ, Hall MJ. National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13. 2006 Oct;(162):1-209.

    Google Scholar 

  2. Anaya DA, Flum DR. Risk of Emergency Colectomy and Colostomy in Patients with Diverticular Disease. Arch Surg. 2005;140(7):681-685.

    Article  Google Scholar 

  3. Biondo S, Golda T, Kreisler E, et al. Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial). Ann Surg. 2014;259(1):38-44.

    Article  Google Scholar 

  4. Moghadamyeghaneh Z, Carmichael JC, Smith BR, Mills S, Pigazzi A, Nguyen NT, Stamos MJ. A comparison of outcomes of emergent, urgent, and elective surgical treatment of diverticulitis. Am J Surg. 2015 Nov;210(5):838-845.

    Article  Google Scholar 

  5. Weizman AV, Nguyen GC. Diverticular disease: epidemiology and management. Can J Gastroenterol. 2011 Jul;25(7):385-389.

    Article  Google Scholar 

  6. Strate LL, Morris AM. Epidemiology, Pathophysiology, and Treatment of Diverticulitis. Gastroenterology. 2019 Apr;156(5):1282-1298.e1.

    Article  Google Scholar 

  7. Humes DJ, West J. Role of acute diverticulitis in the development of complicated colonic diverticular disease and 1-year mortality after diagnosis in the UK: population-based cohort study. Gut. 2012 Jan;61(1):95-100.

    Article  Google Scholar 

  8. Humes DJ, Solaymani-Dodaran M, Fleming KM, Simpson J, Spiller RC, West J. A population-based study of perforated diverticular disease incidence and associated mortality. Gastroenterology. 2009 Apr;136(4):1198-1205.

    Article  Google Scholar 

  9. Morris AM, Regenbogen SE, Hardiman KM, Hendren S. Sigmoid diverticulitis: a systematic review. JAMA. 2014;311(3):287-297.

    Article  CAS  Google Scholar 

  10. Li D, de Mestral C, Baxter NN, et al. Risk of readmission and emergency surgery following nonoperative management of colonic diverticulitis: a population-based analysis. Ann Surg. 2014;260(3):423-431.

    Article  Google Scholar 

  11. Hupfeld L, Pommergaard HC, Burcharth J, Rosenberg J. Emergency admissions for complicated colonic diverticulitis are increasing: a nationwide register-based cohort study. Int J Colorectal Dis. 2018;33(7):879-886.

    Article  Google Scholar 

  12. Amato A, Mataloni F, Bruzzone M, et al. Hospital admission for complicated diverticulitis is increasing in Italy, especially in younger patients: a national database study. Tech Coloproctol. 2020;24(3):237-245.

    Article  CAS  Google Scholar 

  13. 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 

  14. HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2011. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp

  15. HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2012. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp

  16. Ricciardi R, Baxter NN, Read TE, Marcello PW, Hall J, Roberts PL. Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis? Dis Colon Rectum. 2009;52(9):1558-1563.

    Article  Google Scholar 

  17. Slee VN. The International Classification of Diseases: ninth revision (ICD-9). Ann Intern Med. 1978 Mar;88(3):424-426.

    Article  CAS  Google Scholar 

  18. D’Hoore W, Bouckaert A, Tilquin C. Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol. 1996;49:1429-1433.

    Article  Google Scholar 

  19. Mozer AB, Spaniolas K, Sippey ME, Celio A, Manwaring ML, Kasten KR. Post-operative morbidity, but not mortality, is worsened by operative delay in septic diverticulitis. Int J Colorectal Dis. 2017;32(2):193-199.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WACC 460, Boston, MA, 02114, USA

    Naomi M. Sell, Caitlin E. Stafford, Robert N. Goldstone, Hiroko Kunitake, Todd D. Francone, Christy E. Cauley, Richard A. Hodin, Liliana G. Bordeianou & Rocco Ricciardi

Authors
  1. Naomi M. Sell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caitlin E. Stafford
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert N. Goldstone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroko Kunitake
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Todd D. Francone
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christy E. Cauley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard A. Hodin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Liliana G. Bordeianou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rocco Ricciardi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rocco Ricciardi.

Ethics declarations

Statement on Authorship

All authors met the guidelines for authorship as defined by the International Committee of Medical Journal Editors (ICMJE).

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.

This study was presented virtually as an oral presentation at the 2020 American Society of Colon and Rectal Surgeons (ASCRS) Annual Scientific Meeting in June 2020.

Supplementary Information

Supplemental Table 1.

ICD-9 Codes for Procedure Related Complications (DOCX 306 kb)

Supplemental Table 2.

Annual Cases of Diverticulitis Admissions & Rate of Inpatient Mortality (DOCX 261 kb)

Supplemental Table 3.

Patient Disposition Following Hospitalization (DOCX 116 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sell, N.M., Stafford, C.E., Goldstone, R.N. et al. Delay to Intervention for Complicated Diverticulitis is Associated with Higher Inpatient Mortality. J Gastrointest Surg 25, 2920–2927 (2021). https://doi.org/10.1007/s11605-021-04972-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-021-04972-9

Keywords

Search

Navigation