Predictive Factors for Postoperative Complications in Elective Laparoscopic Sigmoid Resections Due to Diverticulitis

Shota Takano, MD, Cesar Reategui, MD, Giovanna da Silva, MD, Eric G Weiss, MD, Steven D Wexner, MD

Cleveland Clinic Florida

INTRODUCTION: Laparoscopic sigmoid colectomy has been universally accepted as the standard surgical treatment for sigmoid diverticulitis. Reported postoperative complication rates range from 7-25%. Predictive factors of complications remain unclear. The aim of this study was to investigate factors predictive factors of postoperative complications following laparoscopic sigmoidectomy for diverticulitis.

METHODS: After IRB approval, the medical records of all patients at our institution who underwent elective laparoscopic sigmoidectomy with anastomosis for diverticulitis between 05/2007 and 07/2011 were reviewed. Collected variables were demographics, body mass index (BMI), comorbidities, American Society of Anesthesiology (ASA) score, previous abdominal surgeries, presence of abscess or fistula, number of diverticulitis attacks, approach type (laparoscopy or hand-assisted), conversion to open, postoperative complications, and hospital stay. These variables were compared between patients who had or did not have postoperative complications. Student’s t-tests and chi-squared tests were performed to analyze continuous and categorical data, respectively. A p-value of <0.05 was considered statistically significant. All univariate predictors with p ≤ 0.2 in logistic regression analysis were included in a multivariate analysis to determine the incidence of surgical complications.

RESULTS: 199 patients underwent laparoscopic sigmoid colectomy for diverticulitis: 94 laparoscopic and 105 hand-assisted. Complications were noted in 61 patients (30.7%). The most common surgical complication was wound infection followed by ileus. In a univariate analysis, ASA, BMI, and abdominal abscess or fistula significantly correlated with postoperative complications (Table). Patients with 3 or fewer attacks had significantly more complications compared to those with 4 or more attacks. In multivariate analyses, older age and higher BMI were independently correlated with higher complication rates (odds ratio [OR] = 1.032 and 1.115, 95% confidence interval [CI] = 1.001-1.065 and 1.038-1.197, p = 0.039 and 0.002). In addition, the incidence of 4 or more attacks was independently correlated with a lower complication rate (OR = 0.485, 95% CI = 0.236-0.999, p = 0.047).

CONCLUSIONS: Older age, higher BMI, and 3 or fewer attacks of diverticulitis are associated with a higher rate of postoperative complications. These 3 factors are considered to be predictive for postoperative complications in elective laparoscopic sigmoid resections due to diverticulitis.

Table. Univariate analyses

No Postoperative Complications (n=138) Postoperative Complications (n=61) P Value
Age (years) 54.9 ± 10.9 57.8 ± 12.8 0.103
Males : Females (n) 70 : 68 29 : 32 0.679
≤ 3 attacks : ≥ 4 attacks 66 : 72 43 : 18 0.003
Hospitalizations (n) 1.5 ± 1.4 1.3 ± 0.9 0.252
BMI (kg /m2) 27.3 ± 4.9 29.9 ± 4.9 <0.001
ASA 1-2 : 3-4 (n) 126 : 12 49 : 12 0.034
Comorbidities (n) 67 (48.6%) 33 (54.1%) 0.470
Previous abdominal surgery (n) 37 (26.8%) 23 (37.7%) 0.126
Preoperative abscess or fistula (n) 28 (20.3%) 24 (39.3%) 0.006
Laparoscopic : Hand-assisted (n) 68 :70 26 : 35 0.385

Session: Poster Presentation

Program Number: P116

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