National Failure-Analysis of Non-Operative Management among Patients Admitted for Diverticulitis
Raymond A Jean, Alexander S Chiu, *Whitney S Brandt, *Lucy Ruangvoravaat, Kimberly A Davis
Yale School of Medicine, New Haven, CT
Objective: To identify factors associated with the need for operative management among patients admitted for colonic diverticulitis.
Design: Retrospective cohort study
Setting: Hospitalized Care
Patients: Discharges from the National Inpatient Sample between 2010 and 2015 of patients who were non-electively admitted from the emergency department with a primary diagnosis of colonic diverticulitis without evidence of malignancy.
Interventions: Discharges with sigmoid, left colon, or rectal resections were compared to those who did not undergo operative management during their hospitalization. Adjusted Cox proportional hazards regression was used to identify patient and hospital factors associated with daily hazard of non-operative failure.
Main Outcome Measures: Risk for operative intervention prior to discharge
Results: A total of 830,993 discharges over the study period, of whom 83,628 (10.1%) underwent operative resection during the initial hospitalization. Among those patients treated operatively, half of all operations (50.5%) occurred by hospital day 1. In an adjusted Cox proportional hazards model, the presence of a peritoneal abscess (HR 3.20, p<0.01) and sepsis (4.16, p<0.01) were the strongest predictors of failing non-operative management. Paradoxically, octogenarians (HR 0.81, p<0.01) and nonagenarians (HR 0.43, p<0.01) showed a lower risk of failing non-operative management.
Conclusions: Overall 10.1% of unplanned admissions for diverticulitis result in inpatient operative resection, most of which occur on the day of admission. The presence of abscess and sepsis were predictive of surgical intervention. Although there was a trend for increasing risk of failure with increasing age, this reversed among those at the extremes of old age.
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