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Laparoscopic Surgery for Sigmoid Diverticulitis is Grossly Underestimated
*Jorunn Atladottir, Walter Longo, *Vikram Reddy
Yale University, New Haven, CT

Objective: Laparoscopic surgery for diverticulitis in the United States has been reported to be less than 15% for elective surgery. This may be artificially low due to inaccurate case identification due to miscoding for laparoscopy in administrative databases. The aim of this study was to evaluate the use of laparoscopy for elective management of diverticulitis, and to identify factors associated with its use.

Design : All patients undergoing elective colectomy for sigmoid diverticulitis were identified in the Nationwide Inpatient Sample Database from 2008-2010. The proportion of patients undergoing laparoscopic surgery was identified. Multivariate regression modeling was used to identify patient and hospital characteristics associated with increased utility of laparoscopy for diverticulitis. Results: In the study period, 12,981 patients underwent colectomy for sigmoid diverticulitis, 54.7% were done laparoscopically. Use of laparoscopy increased across all populations in the study period. Patients were less likely to undergo laparoscopic resections if they were older (AOR = 0.8, 0.7 and 0.4 for the 41-60, 61-80, and >80 years age groups), were African-American (AOR = 0.6), had chronic medical conditions (AOR = 0.8 and 0.5 for 1-2 and >2 chronic conditions), had Medicaid or Medicare (AOR = 0.7), or were self-pay (AOR = 0.4), and more likely to undergo laparoscopic resections if they had higher incomes (AOR = 1.4
and 2.0 for the highest two quartiles). Treatment at medium and large hospitals (AOR = 1.6 and 1.4) and urban hospitals (AOR =1.6) resulted in increased use of laparoscopy.

Conclusion: Laparoscopic resections for sigmoid diverticulitis are higher than those previously reported in administrative database. Socioeconomic status, multiple comorbidities, and surgery at large urban hospital define the surgical approach.

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