Elective Surgery for Diverticulitis Is Associated with High Risk of Intestinal Diversion and Hospital Readmission in Older Adults
Anne O. Lidor*1, Eric B. Schneider1, Amy Sheer2, Albert W. Wu2, Jodi B. Segal2, Robert Herbert2, David C. Chang1
1Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 2Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Purpose: To describe and compare patient outcomes (rates of in-hospital mortality, intestinal diversion and 30-day readmission) in older adults undergoing emergent/urgent versus elective surgery for diverticulitis. Methods: Retrospective cohort study. Data were derived from the longitudinal 100% MEDPAR (Medicare Provider Analysis and Review) inpatient file from 2004-2007. All patients age 65 years and older with a primary diagnosis of diverticulitis who underwent left colon resection, colostomy, or ileostomy were included. The primary outcome was in-hospital mortality. Secondary outcomes included intestinal diversion and readmission within 30-days post discharge (including admissions to rehabilitation services). Patients were categorized for comparison into emergent/urgent (EU) versus elective (E) surgery, as defined by admission type. Multivariate logistic regression was performed adjusting for age, gender, race, and medical comorbidity as measured by the Charlson Index. Results: The sample included 66,859 patients, with 38,411 (47.4%) EU and 28,448 (42.6%) E. On average, EU patients were older (77.1 vs. 74.0 years, p<0.001) and less likely to be female (65.5% vs. 71.3%, p<0.001). EU patients had greater in-hospital mortality (8.7% vs 1.5%, p<0.001), a higher intestinal diversion rate (59.2% vs 12.5%, p<0.001), and a higher 30-day readmission rate (24.0% vs 13.2%, p<0.001). After adjustment for baseline risk factors, EU patients had significantly greater odds of in-hospital mortality (OR 4.2, 95% CI, 3.8-4.7), intestinal diversion (OR 9.4, 95% CI 9.0-9.8), and 30-day readmission (OR 1.8, 95% CI 1.75-1.91).Conclusions: As expected, older adults undergoing elective surgical treatment for diverticulitis have significantly reduced risks of poor outcomes compared to emergent/urgent patients. However, even among elective patients, there were surprisingly high rates of intestinal diversion and 30-day readmission. These outcomes suggest that for older patients with diverticulitis, current recommendations for elective surgical intervention may need to be re-examined. Surgical treatment for these patients should be compared to non-operative strategies.
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