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Short Term Complications after Elective Surgery for Acute Diverticulitis
Anne F. Peery*1, Monica Schmidt1,2, Mark Koruda 3
1Gastroenterology, University of North Carolina, Chapel Hill, NC; 2Carolinas Medical Center, Charlotte, NC; 3GI Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC
Background & Aims: Elective surgery to prevent recurrent acute diverticulitis is common. Despite how frequently surgery is performed, complications are poorly described. The aim of this study was to describe the risk of 30-day complications after elective surgery for acute diverticulitis and to determine predictors for complications.
Methods: We analyzed data collected prospectively as part of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). The NSQIP is a national voluntary program that allows hospitals to measure and improve the quality of surgical care. Trained reviewers collect data on preoperative factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgery. We included all patients in NSQIP between 2011 and 2013 over the age of 18 who had an elective surgery and a postoperative diagnosis of diverticulitis without hemorrhage (ICD-9 code 562.11) and a Current Procedural Terminology code for colectomy. We excluded anyone with pre-operative systemic sepsis or prior operation within 30 days. We also excluded anyone with an abscess or other evidence of infection noted preoperatively or intraoperatively at surgical area at time of surgery. We assessed predictors for complications using Poisson regression to estimate incident risk ratios and 95% confidence intervals.
Results: Our analyses included 14,835 patients. A quarter (24%) of this cohort was under the age of 50. Almost half (47%) were over the age of 60. Most patients were either overweight (36%) or obese (40%). A laparoscopic surgical approach was more frequent (68%) than an open surgical approach (32%). One in 13 patients (8%) had a surgery that resulted in a colostomy. An open surgical approach was more likely to result in a colostomy than a laparoscopic approach (adjusted IRR 5.7; CI 3.8-8.6). Postoperative infections within 30 days of surgery were common. The prevalence of superficial surgical site infections was 6.6%, deep incisional site infections was 1.1%, abscesses 2.6% and wound dehiscence 1%. Participants who had an obese body mass index (≥ 30) had an increased risk of deep incisional site infection, abscess and/or wound dehiscence (IRR 1.8; 95% CI 1.0-3.2) compared to those with a normal body mass index (18.5-24.9). The risk of postoperative sepsis or septic shock was 3.7%. Within 30 days of surgery, 7.5% of the cohort had an unplanned readmission and 3.9% had an unplanned return to the operating room for a surgical procedure related to the index operation. Thirty-day mortality was rare (0.3%).
Conclusions: One in 13 patients who have elective surgery for acute diverticulitis will have a colostomy. Postoperative infections, reoperations and readmissions are common within 30 days of surgery. Patients need to understand these risks before considering elective surgery.
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