Elective Surgery for Diverticulitis is Associated with High Risk of Intestinal Diversion and Hospital Readmission in Older Adults

Anne O. Lidor, Eric Schneider, Jodi Segal, Qilu Yu, Richard Feinberg, Albert W Wu

Research output: Contribution to journalArticle

Abstract

Purpose: This study seeks to compare outcomes (in-hospital mortality, colostomy rates, and 30-day readmission rates) in older adult patients undergoing emergency/urgent versus elective surgery for diverticulitis. Methods: Data were derived from the 100% Medicare Provider Analysis and Review (MEDPAR) inpatient file from 2004-2007. All patients 65 years of age and above with a primary diagnosis of diverticulitis that underwent left colon resection, colostomy, or ileostomy were included. The primary outcome variable was in-hospital mortality. Secondary outcome variables included intestinal diversion, 30-day post-discharge readmission rates, discharge destination, length of stay, and total charges. Patients were grouped in two categories for comparison: emergent/urgent (EU) versus elective surgery, as defined by admission type. Multivariate analysis was performed adjusting for age (categorized by five groups), gender, race, and medical comorbidity as measured by Charlson Index. Results: Fifty-three thousand three hundred sixteen individuals were eligible for inclusion, with 23,764 (44. 6%) in the elective group. On average, EU patients were older (76.8 vs. 73.9 years of age, p <0.001) and less likely to be female (65.4% vs. 71.1%, p <0.001). EU patients had higher in-hospital mortality (8.0% vs. 1.4%, p <0.001), higher intestinal diversion rates (64.2% vs. 12.7%, p <0.001), and higher 30-day readmission rates (21.4% vs. 11.9%, p <0.001) and the worse outcomes persisted even after adjustment for risk factors. Unadjusted and adjusted mortality rates dramatically increased by age, although the affect of age on mortality was more pronounced in the elective group where mortality rates ranged from 0.56% in patients 65-69 years old to 6.5% in patients 85+ years old. The rates of ostomy and 30-day readmission generally increased with age, with worse outcomes noted particularly in the elective group. Conclusions: As expected, older adults undergoing emergent/urgent surgical treatment for diverticulitis have significantly increased risks of poor outcomes compared with elective patients. While advancing age is associated with a substantial increase in mortality, intestinal diversion and 30-day readmission after surgery for diverticulitis, this affect is especially evident among patients undergoing elective colectomy. Our data suggest that given the considerable risk of prophylactic colon resection in elderly patients with sigmoid diverticulitis, a reappraisal of the proper role of elective colectomy in this population may be warranted.

Original languageEnglish (US)
Pages (from-to)1867-1874
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume14
Issue number12
DOIs
StatePublished - Dec 2010

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Patient Readmission
Diverticulitis
Hospital Mortality
Mortality
Colostomy
Colectomy
Colon
Ostomy
Ileostomy
Sigmoid Colon
Medicare
Comorbidity
Inpatients
Length of Stay
Emergencies
Multivariate Analysis

Keywords

  • Diverticular disease
  • Elderly
  • Prophylactic colectomy
  • Sigmoid diverticulitis
  • Surgical outcomes

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Elective Surgery for Diverticulitis is Associated with High Risk of Intestinal Diversion and Hospital Readmission in Older Adults. / Lidor, Anne O.; Schneider, Eric; Segal, Jodi; Yu, Qilu; Feinberg, Richard; Wu, Albert W.

In: Journal of Gastrointestinal Surgery, Vol. 14, No. 12, 12.2010, p. 1867-1874.

Research output: Contribution to journalArticle

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abstract = "Purpose: This study seeks to compare outcomes (in-hospital mortality, colostomy rates, and 30-day readmission rates) in older adult patients undergoing emergency/urgent versus elective surgery for diverticulitis. Methods: Data were derived from the 100{\%} Medicare Provider Analysis and Review (MEDPAR) inpatient file from 2004-2007. All patients 65 years of age and above with a primary diagnosis of diverticulitis that underwent left colon resection, colostomy, or ileostomy were included. The primary outcome variable was in-hospital mortality. Secondary outcome variables included intestinal diversion, 30-day post-discharge readmission rates, discharge destination, length of stay, and total charges. Patients were grouped in two categories for comparison: emergent/urgent (EU) versus elective surgery, as defined by admission type. Multivariate analysis was performed adjusting for age (categorized by five groups), gender, race, and medical comorbidity as measured by Charlson Index. Results: Fifty-three thousand three hundred sixteen individuals were eligible for inclusion, with 23,764 (44. 6{\%}) in the elective group. On average, EU patients were older (76.8 vs. 73.9 years of age, p <0.001) and less likely to be female (65.4{\%} vs. 71.1{\%}, p <0.001). EU patients had higher in-hospital mortality (8.0{\%} vs. 1.4{\%}, p <0.001), higher intestinal diversion rates (64.2{\%} vs. 12.7{\%}, p <0.001), and higher 30-day readmission rates (21.4{\%} vs. 11.9{\%}, p <0.001) and the worse outcomes persisted even after adjustment for risk factors. Unadjusted and adjusted mortality rates dramatically increased by age, although the affect of age on mortality was more pronounced in the elective group where mortality rates ranged from 0.56{\%} in patients 65-69 years old to 6.5{\%} in patients 85+ years old. The rates of ostomy and 30-day readmission generally increased with age, with worse outcomes noted particularly in the elective group. Conclusions: As expected, older adults undergoing emergent/urgent surgical treatment for diverticulitis have significantly increased risks of poor outcomes compared with elective patients. While advancing age is associated with a substantial increase in mortality, intestinal diversion and 30-day readmission after surgery for diverticulitis, this affect is especially evident among patients undergoing elective colectomy. Our data suggest that given the considerable risk of prophylactic colon resection in elderly patients with sigmoid diverticulitis, a reappraisal of the proper role of elective colectomy in this population may be warranted.",
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AU - Lidor, Anne O.

AU - Schneider, Eric

AU - Segal, Jodi

AU - Yu, Qilu

AU - Feinberg, Richard

AU - Wu, Albert W

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KW - Elderly

KW - Prophylactic colectomy

KW - Sigmoid diverticulitis

KW - Surgical outcomes

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