S. Groene1, C. Chandrasekera1, T. Prasad1, A. Lincourt1, B. T. Heniford1, V. Augenstein1 1Carolinas Medical Center,Division Of Gastrointestinal And Minimally Invasive Surgery,Charlotte, NC, USA
Introduction: Colorectal diverticular disease occurs in about 3% of the population and at times it can result in significant complications such as perforations, abscesses or fistulae. Surgery is recommended for most complicated cases of diverticulitis. The aim of this study was to compare outcomes of patients with and without diverticular disease following colorectal surgery.
Methods: Review of the Carolinas Medical Center (CMC) NSQIP data for colorectal procedures performed from 2013 to 2015 was conducted. Patients were considered to have or had had diverticulitis based upon ICD-9 codes (562.11, 562.13). Demographics, pre-operative co-morbidities, minor and major complications were evaluated using standard statistical methods.
Results: There were 637 patients in the sample; 109 patients had the diagnosis of diverticulitis, 528 with other diagnoses, including neoplasms (63.2%), IBD (2.7%), infectious disease (3.2%), ischemia (4.7%) and obstruction (6.1%). There were no significant differences between the groups in terms of age, race, gender or other medical co-morbidities. Those with diverticulitis underwent laparoscopic surgery more often (75.2% vs 63.5%; p=0.02) than those with other diagnoses. However, those without the diagnosis of diverticulitis tended to have a higher rate of pre-operative steroid use (8.9% vs 1.8%; p=0.01), a higher rate of pre-operative transfusions (7.4% vs 1.8%; p=0.03) and a greater chance of pre-operative weight loss of ≥ 10 pounds (5.5% vs 0.9%; p=0.04). The proportion of emergent cases were similar between the 2 groups (10.1% vs 11.3%; p=0.59). Those with the diagnosis of diverticulitis had a lower rate of post-operative transfusions (3.7% vs 21.8%; p<0.001) and a shorter post-operative length of stay (6.7±5d vs 10.3±9.6d; p<0.001). After controlling for pre-op transfusions, ASA class and pre-op sepsis, multivariate analysis indicated patients with diverticulitis required fewer post-op transfusions with OR 0.17 (95% CI 0.06, 0.49) and had a shorter LOS (adjusted mean13.4d vs 15.3d; p=0.02). There were no significant differences in post-operative surgical site infections, pneumonia, UTIs, sepsis, anastomotic leaks, unplanned returns to the OR, cardiac or renal disease, DVTs/PEs and 30 day mortality between the 2 groups.
Conclusion: Patients with and without diverticulitis had similar demographic characteristics and pre-operative co-morbidities. Those with diverticulitis required fewer transfusions, both pre and post-operatively. They also had a shorter length of stay and did not require more emergent surgeries compared to those without diverticulitis. Surgery, including laparoscopy, can be performed on those with colorectal diverticular disease with similar outcomes to those requiring surgery for other reasons.