Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 12/2018

01-12-2018

Surgical outcomes for diverticulitis in young patients: results from the NSQIP database

Authors: Meara Dean, Herman Kessler, Emre Gorgun

Published in: Surgical Endoscopy | Issue 12/2018

Login to get access

Abstract

Background

The incidence of diverticulitis is increasing among young patients (≤ 50 years), as are rates of recurrent disease. There is ongoing controversy regarding the best management strategy for this patient group. Guidelines have changed from elective colectomy after a single episode to a more individualized approach no longer based on patient age. This study investigated the clinical presentation and surgical outcomes of young patients undergoing surgery for diverticulitis over two time periods.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was searched from 2005 to 2014 to identify all patients ≤ 50 with a diagnosis of diverticulitis. Data were obtained on patient demographics, comorbidity, perioperative details, and 30-day post-operative outcomes. Data were compared between two time periods, being 2005–2010 (Group 1) and 2011–2014 (Group 2).

Results

10,844 patients were included in the analysis. The mean patient age was 43 years (range 18–50), and 35% were female. Significantly more patients were obese (BMI > 30) in Group 2 (52%) versus Group 1 (47%). Laparoscopic surgery and emergency surgery and perforation rates were significantly higher in Group 2. Wound infection was significantly less in Group 2. Post-operative organ/space infection and medical morbidity were significantly higher in Group 2.

Conclusions

In recent years, there has been a change to a more conservative approach for elective colonic resection in young patients with a history of diverticulitis. Increasingly young patients presenting for surgery for diverticulitis are male and obese, and increased rates of post-operative medical morbidity have been observed. The laparoscopic approach is more common, with resultant increased operative times, and decreased wound infection rates. The observed increased in emergency surgery and perforation rates may be explained by the change in management approach with less elective resections.
Literature
1.
Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM (2009) Diverticulitis in the United States 1998–2005: changing patterns of disease and treatment. Ann Surg 249:210–217CrossRef
2.
Nguyen GC, Sam J, Anand N (2011) Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States. World J Gastroenterol 17:1600–1605CrossRef
3.
Bharucha A, Gopanandan P, Ditah I, Fletcher JG, Ewelukwa O, Pendlimari R, Yawn B, Melton L, Schleck C, Zinsmeister A (2015) Temporal trends in the incidence and natural history of diverticulitis: a population based study. Am J Gastroenterol 110:1589–1596CrossRef
4.
Wong D, Wexner S (2000) Practice parameters for the treatment of sigmoid diverticulitis—supporting documentation. Dis Colon Rectum 43(3):290–297CrossRef
5.
Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie D, Rafferty J (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57(3):284–294CrossRef
6.
Anaya DA, Flem DR (2005) Risk of emergency colectomy and colostomy in patient with diverticular disease. Arch Surg 140:681–685CrossRef
7.
Katz L, Guy D, Lahat A, Gafter-Gvili A, Bar-Meir S (2013) Diverticulitis in the young is not more aggressive than in the elderly, but it tends to recur more often: systemic review and meta-analysis. J Gastroenterol Hepatol 28:1274–1281CrossRef
8.
Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4:53–69PubMed
9.
Almy TP, Howell DA (1980) Diverticular disease of the colon. N Engl J Med 302:324–331CrossRef
10.
Painter NS, Burkitt DP (1975) Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 4:3–21PubMed
11.
Etzioni DA, Cannom RR, Ault GT, Beart RW, Kaiser AM (2009) Diverticulitis in California from 1995 to 2006: increased rates of treatment for younger patients. Am Surg 75:981–985PubMed
12.
Jena M, Marcello P, Roberts P, Read T, Schoetz D, Hall J, Francone T, Ricciardi R (2016) Epidemiolgic analysis of diverticulitis. Clin Colon Rectal Surg 29:258–263CrossRef
13.
Bharucha A, Parthasarathy G, Ditah I et al (2016) Temporal trends in the incidence and natural history of diverticulitis: a population-based study. Am J Gastroenterol 110:1589–1596CrossRef
14.
Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL (2009) Obesity increases the risk of diverticulitis and diverticular bleeding. Gastroenterology 136(1):115–122CrossRef
15.
Dobbins C, Defontgalland D, Duthie G, Wattchow DA (2006) The relationship of obesity to the complications of diverticular disease. Colorectal Dis 8(1):37–40CrossRef
16.
Rosemar A, Angeras U, Rosengren A (2008) Body mass index and diverticular disease: a 28 year follow up study in men. Dis Colon Rectum 51(4):450–455CrossRef
17.
Oomen JL, Engel AF, Cuesta MA (2006) Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors. Color Dis 8:112–119CrossRef
18.
Bailey M, Davenport D, Procter L, McKenzie S, Vargas D (2013) Morbid obesity and diverticulitis: results from the ACS NSQIP dataset. J Am Coll Surg 217:874–880CrossRef
19.
Makino T, Shukla PJ, Rubino F, Milsom JW (2012) The impact of obesity on peri operative outcomes after laparoscopic colorectal resection. Ann Surg 255:228–236CrossRef
20.
Ricciardi R, Baxter N, Read T, Marcello P, Hall J, Roberts P (2009) Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis? Dis Colon Rectum 52:1558–1563CrossRef
Metadata
Title
Surgical outcomes for diverticulitis in young patients: results from the NSQIP database
Authors
Meara Dean
Herman Kessler
Emre Gorgun
Publication date
01-12-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6256-3

Other articles of this Issue 12/2018

Surgical Endoscopy 12/2018 Go to the issue

OriginalPaper

Does obesity impact postoperative outcomes following robotic-assisted surgery for rectal cancer?

2018 SAGES Oral

Simulation-based mastery learning significantly reduces gender differences on the Fundamentals of Endoscopic Surgery performance exam

OriginalPaper

Cost-effectiveness analysis of laparoscopic versus open surgery in colon cancer

OriginalPaper

Total minimally invasive esophagectomy for esophageal adenocarcinoma reduces postoperative pain and pneumonia compared to hybrid esophagectomy

OriginalPaper

Treatment of differentiated thyroid cancer: can endoscopic thyroidectomy via a chest-breast approach achieve similar therapeutic effects as open surgery?

OriginalPaper

Evaluation of VTE prophylaxis and the impact of alternate regimens on post-operative bleeding and thrombotic complications following bariatric procedures