Risk of operation intervention after percutaneous drainage for complicated diverticulitis
Alexander Chiu, Raymond Jean, *Whitney Brandt, *Lucy Ruangvoravat, Kimberly Davis
Yale School of Medicine, New Haven, CT
Objective(s): Percutaneous drainage has become a common method to manage complicated diverticulitis, yet some patients still require an operation the same admission. We evaluated risk factors associated with operative intervention after percutaneous drainage for complicated diverticulitis.
Design: Retrospective cohort study.
Setting: Hospital inpatient admissions in the National Inpatient Sample between 2010-2015.
Patients: Adults>17 admitted for diverticulitis and who received a percutaneous drain.
Interventions: Percutaneous drainage and subsequent lap or open sigmoidectomy, partial colectomy, or rectal resection.
Main Outcome Measure(s): Percent and factors associated with undergoing same admission surgery after percutaneous drainage.
Results: Among the 830,993 patients admitted for diverticulitis, 31,381 underwent percutaneous drainage (3.5%). The average time from admission to drain placement was 2.3 days (SD 5.7). 3,466 (11.0%) patients subsequently had an operation the same admission. The average time from drainage to operation was 5.9 days (SD 9.0). Those requiring an operation had an average total length of stay of 18.5 days (SD 19.6) compared to 7.1 days (SD 10.9) for percutaneous drain only (p<.01). Multivariate regression demonstrated that sepsis was most strongly associated with eventual operation (OR 7.52 [95%CI 6.62-8.55]), followed by multiple co-morbidities (OR 4.08 [95%CI 3.57 -4.66]). As age increased, there was a progressive decrease in odds of operation. Finally, Asian (OR 0.18 [95%CI 0.09-0.38]) and Black (OR 0.48 [95%CI 0.41-0.57]) race were associated with decreased odds of operation compared to white race, while there was no difference for Hispanics (OR 0.92 [95%CI 0.81-1.04]).
Conclusions: Among requiring percutaneous drainage for complicated diverticulitis, 11% require operative intervention the same hospitalization. Patients with sepsis and multiple comorbidities were most likely to require an operation and may benefit from earlier operative intervention.
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