T. Gaglani1, C. H. Davis2, E. P. Askenasy1, M. V. Cusick1,2 1The University of Texas Health Science Center at Houston,Department Of Surgery,Houston, TEXAS, USA 2Houston Methodist Hospital,Department Of Surgery,Houston, TEXAS, USA
Introduction: The prevalence of diverticular disease has been increasing over the last 25 years in western society. While diverticulitis was traditionally viewed as a disease of older individuals, the incidence in patients ages 18 to 44 has increased by 82 percent over the last 20 years. Additionally, it has been observed that young Hispanic men are more likely to have severe diverticular disease. This study aims to ascertain a demographic correlation between age and ethnicity with severity of diverticular disease and required surgical intervention.
Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, patients with primary diagnosis of diverticulitis undergoing surgical intervention in 2016 were identified. Severity of disease (as determined by ICD 10 code) and extent of intervention (as determined by CPT code) were then compared between Hispanic and non-Hispanic patients focusing on comparing young (age<50) Hispanic males to young non-Hispanic males using Fisher’s exact test.
Results: A total of 11,045 operations were performed on patients diagnosed with diverticulitis. Of these cases, 731(6.6%) were performed in Hispanic patients. The mean ages of the Hispanic and non-Hispanic patients were 52.7 and 59.4 years, respectively. Of all 5,010 male patients requiring surgery for diverticulitis, Hispanics were almost twice as likely than non-Hispanics to present at age <50 (53.1% vs. 30.4%, p<0.001). More young Hispanic males had perforated diverticulitis (143/310) compared to non-Hispanic males (844/2205), 46.1% vs. 38.3%, respectively (p=0.009). In terms of more invasive procedures, 42.6% of young Hispanic males underwent open operations vs. 33.8% of young non-Hispanic males (p=0.007; male and female combined, 39.7% vs 33.0%, respectively, p=0.021). More young Hispanics required a stay of 7 or more hospital days than young non-Hispanics (31.2% vs. 25.1%, respectively, p=0.015).
Conclusion: These data indicate that diverticular disease often presents at an earlier age in the Hispanic population. Further, young Hispanic males had nearly double the rate of surgical intervention for diverticulitis. Additionally young Hispanic males had significantly longer length of stay suggesting a higher level of complexity. Further studies are needed to assess differences in operative technique and outcome. This study is limited as it only considered operative diverticulitis patients and not those managed non-operatively.