Outcomes and costs of elective surgery for diverticular disease: a comparison with other diseases requiring colectomy. JAMA Surg 2013 Apr;148(4):316-21
Date
05/30/2013Pubmed ID
23715829DOI
10.1001/jamasurg.2013.1010Scopus ID
2-s2.0-84876814650 (requires institutional sign-in at Scopus site) 57 CitationsAbstract
OBJECTIVE: To compare outcomes and costs of elective surgery for diverticular disease (DD) with those of other diseases commonly requiring colectomy.
DESIGN: Multivariable analyses using the Nationwide Inpatient Sample to compare outcomes across primary diagnosis while adjusting for age, sex, race, year of admission, and comorbid disease.
SETTING: A sample of US hospital admissions from 2003-2009.
PATIENTS: All adult patients (≥18 years) undergoing elective resection of the descending colon or subtotal colectomy who had a primary diagnosis of DD, colon cancer (CC), or inflammatory bowel disease (IBD).
MAIN OUTCOME MEASURES: In-hospital mortality, postoperative complications, ostomy placement, length of stay, and hospital charges.
RESULTS: Of the 74,879 patients, 50.52% had DD, 43.48% had CC, and 6.00% had IBD. After adjusting for other variables, patients with DD were significantly more likely than patients with CC to experience in-hospital mortality (adjusted odds ratio, 1.90; 95% CI, 1.37-2.63; P < .001), develop a postoperative infection (1.67; 1.48-1.89; P < .001), and have an ostomy placed (1.87; 1.65-2.11; P < .001). The adjusted total hospital charges for patients with DD were $6678.78 higher (95% CI, $5722.12-$7635.43; P < .001) and length of stay was 1 day longer (95% CI, 0.86-1.14; P < .001) compared with patients with CC. Patients with IBD had the highest in-hospital mortality, highest rates of complications and ostomy placement, longest length of stay, and highest hospital charges.
CONCLUSIONS: Despite undergoing the same procedure, patients with DD have significantly worse and more costly outcomes after elective colectomy compared with patients with CC but better than patients with IBD. These relatively poor outcomes should be recognized when considering routine elective colectomy after successful nonoperative management of acute diverticulitis.
Author List
Van Arendonk KJ, Tymitz KM, Gearhart SL, Stem M, Lidor AOMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Chi-Square Distribution
Colectomy
Colonic Neoplasms
Colostomy
Comorbidity
Diverticulitis
Elective Surgical Procedures
Female
Hospital Charges
Hospital Mortality
Humans
Inflammatory Bowel Diseases
Length of Stay
Logistic Models
Male
Middle Aged
Postoperative Complications
Retrospective Studies
United States