A. Kazi1, T. B. Finco1, B. Zakhary1, M. Firek1, A. Gerber1, M. Brenner1, R. Coimbra1 1Riverside University Health System,Comparative Effectiveness And Clinical Outcomes Research Center,Moreno Valley, CA, USA
Introduction: The impact of cirrhosis in the outcome of acute surgical diseases has been poorly studied. This study was set out to investigate the impact of cirrhosis on outcomes of patients treated either conservatively or surgically for acute diverticulitis. We hypothesized that cirrhotic patients would fare worse and cost of care would be higher when compared to non-cirrhotics (NC) regardless of the type of management.
Methods: A cross-sectional study was performed using the Nationwide Inpatient Sample (NIS) 2012-2014. Patients requiring a hospital admission for acute diverticulitis were stratified in cirrhotics and NC. Cirrhotics were further divided into compensated (CC) and decompensated cirrhosis (DC). Demographics, length of hospital stay (LOS), complications, mortality rate, and hospital adjusted cost were compared between groups. Additionally, CC, DC and NC patients were also stratified according to the type of management utilized: conservative (Non-Op), open colon resection(OCR), and laparoscopic colon resection (LCR), to determine which management option is accompanied by better outcomes. Bonferroni pairwise Chi Squared Analysis with adjustments for each of the multiple variables within the chi squared analysis was used for comparison between groups. A p value < 0.05 was considered statistically significant.
Results: Overall, 234,575 patients were hospitalized with the diagnosis of acute diverticulitis during the study period. Compared to NC, a predominance of male gender, longer LOS, higher mortality, and higher cost, were observed in the cirrhotic groups (CC and DC, p<0.001). Additionally, DC had higher incidence of peritonitis, acute MI, DVT/PE, C. difficile infection, intra-operative bleeding and SSI when compared to NC and CC (p<0.001). NC had lower incidence of UTI compared to cirrhotics (CC and DC) and were more likely to have private insurance including HMO, while CC and DC were more often insured by government programs or were non-insured (p<0.001). Consistently, a marked increase in LOS, cost, and mortality rate was observed in DC regardless of the management strategy used. LCR was found to be superior to OCR in NC as well as CC and DC, leading to shorter LOS, lower costs, and significantly decreased mortality rate (Table; p<0.001).
Conclusion: The presence of cirrhosis markedly impacts outcomes of patients with acute diverticulitis, leading to prolonged hospitalization, higher cost and increased incidence of complications and deaths. LCR offers the best outcomes in patients requiring surgical management, including those with decompensated cirrhosis.
