Steroids Are Independently Associated with Mortality in Patients Requiring Emergent Surgery for Acute Diverticulitis

Megan Sippey, MD, Mark Manwaring, MD, Kevin Kasten, MD, Anthony Mozer, MD, Marysia Grzybowski, PhD, John Pender, MD, William Chapman, MD, Walter Pofahl, MD, Konstantinos Spaniolas, MD. East Carolina University

Introduction: Overall mortality from diverticulitis has plateaued over the past decade. Case reports and small case series suggest patients with diverticular disease taking chronic corticosteroids are predisposed to perforation and their ability to contain early stages of perforation may be impaired. However, no large scale study has examined this population. The aim of this study was to assess the relationship between chronic corticosteroid use and mortality in patients with acute diverticulitis.

Methods: Patients undergoing emergent surgery for acute diverticulitis from 2005 to 2012 were identified from the ACS-NSQIP database. Demographics, co-morbidities, pre-operative lab values, operative procedures and 30-day outcomes were analyzed. Multivariate logistic regression was used with mortality as the dependent variable.

Results: A total of 3,636 patients underwent emergent surgery for acute diverticulitis between 2005 and 2012; 48.9% were male with mean age of 62.63 ± 14.21 years and BMI of 29.44 ± 7.13. Overall 30-day mortality was 6.6% and steroid use was present in 572 (15.7%) patients. Mortality was higher in those taking steroids for chronic conditions (17.5% vs. 4.6%, p<0.0001). Advanced age, vascular, cardiac, pulmonary, neurological, hepatic, renal disease, recent chemotherapy and diabetes were more prevalent in those who died. After controlling for confounding baseline variables, steroid use (OR 2.389, 95% CI 1.557 – 3.666, p<0.0001), along with neurological, pulmonary, hepatic disease and preoperative chemotherapy, was independently associated with mortality in patients requiring emergent surgery for acute diverticulitis. The overall model had a strong ability to discriminate between patients who died and survived (c=0.86, p<0.0001). Laparoscopic approach was utilized in 182 (5.0%) patients in this emergent setting, though when compared to the open approach in this population, mortality was similar (3.2% vs 2.0%, p=0.5286).

Conclusions: Chronic steroid use among patients treated with emergent surgery for acute diverticulitis is frequent and is associated with 17.5% mortality. Surgeons need to inform patients of realistic expectations prior to surgery. Though infrequently used in the emergent setting, the laparoscopic approach is not associated with a difference in mortality for acute diverticulitis in those taking chronic corticosteroids.

Key Words: Corticosteroids, Acute Diverticulitis, Mortality

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