Meara Dean, Hande Aydinli, Hermann Kessler, Emre Gorgun. Cleveland Clinic
Introduction: Recent epidemiological studies have reported changing patterns of diverticular disease in the American population. The incidence of diverticulitis is increasing among the young (<50 years), as are the rates of recurrent disease. There is ongoing controversy regarding the best management strategy for this group. Traditionally elective colectomy was recommended after a single episode, this has changed to a less aggressive approach. Current ASCRS guidelines recommend an individualized approach with selective use of elective colectomy rather than routine elective resection based on age.
This study investigates the clinical presentation and surgical outcomes of young patients presenting with diverticulitis using the ACS NSQIP database, and compares these outcomes over two time periods, being 2005-2010 and 2011-2014. It was expected the change to a more conservative management approach for this patient group has not resulted in any change to severity at presentation, rates of emergent procedures, rates of Hartmanns procedures, or rates of surgical complications.
Methods and Procedures: The NSQIP dataset from 2005-2014 was searched to identify all patients < 50 year with diagnosis of diverticulitis (ICD-9 code 562.11). Patients with disseminated carcinoma or recent chemo or radiotherapy and were excluded. Data was collected regarding patient demographics, clinical presentation, intra operative details and 30 day post-operative outcomes.
Results: 11648 patients were included in the analysis. The average age was 42.2 years and 35.1% were female. 53.2% of patients were obese (BMI > 30) or extremely obese (BMI > 40). Group 1 (2005-2010) had 4643 patients, Group 2 (2011-2014) had 7005 patients. Co morbidities were comparable between groups with the exception of diabetes and obesity (p > 0.05). Rates of pre operative sepsis, Hartmanns procedure, perforation rates and post operative complications were similar between the groups. The laparoscopic surgical approach use more in Group 2 (65%) vs. Group 1 (53%) (p< 0.05). The rate of emergency surgery was significantly higher in Group 2 (24.1%) vs. Group 1 (12.8%) (p < 0.05).
Conclusions: Young patients presenting for surgery for diverticulitis are likely to be male and obese. Over time, with a change in management, the rates of pre-operative sepsis, Hartmann’s procedures, perforation or post-operative complications have not changed significantly, while rates of laparoscopic surgery have increased (p< 0.05).The observed increase in emergency surgery rates demonstrated may be due to the temporal effects of the change in management approach in terms of reduced elective cases, or a true change in the incidence of this disease among this population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79540
Program Number: P197
Presentation Session: Poster (Non CME)
Presentation Type: Poster