JOURNAL ARTICLE

Surgery for diverticulitis is associated with high risk of in-hospital mortality and morbidity in older patients with end-stage renal disease

Erin Moran-Atkin, Miloslawa Stem, Anne O Lidor
Surgery 2014, 156 (2): 361-70
24957670

INTRODUCTION: End-stage renal disease (ESRD) is associated with poor medical outcomes. This study aimed to compare early outcomes of elective and emergency operation for diverticulitis among older adults with and without a diagnosis of ESRD.

METHODS: Patients 65 years of age and older with a primary diagnosis of diverticulitis who underwent operative intervention were identified in the 100% Medicare Provider Analysis and Review (MEDPAR) inpatient file from 2004 to 2007. Outcomes between the ESRD and non-ESRD patients (elective and emergent) undergoing operation for diverticulitis were compared. A subgroup analysis in patients only undergoing elective or emergent operation was performed. Multivariable analyses were conducted. In addition, a propensity-matched analysis was applied comparing early outcomes between ESRD patients and well-matched controls consisting of non-ESRD patients.

RESULTS: A total of 53,560 patients were identified, with 996 (1.86%) ESRD patients. After propensity matching, 962 ESRD and well-matched non-ESRD patients were identified. In the matched cohort, ESRD patients had greater rates of in-hospital mortality (30.9% vs 7.9%, P < .001), shock/sepsis, pulmonary compromise, wound infection, and acute myocardial infarction. An ostomy was placed more frequently in the ESRD patients (71.3% vs 58.7%, P < .001). Duration of stay and hospital charges also were greater in the ESRD group (18 vs 11 days, P < .001; $137,998.3 vs $67,502.2, P < .001). Similar results were seen when outcomes between matched elective ESRD and elective non-ESRD patients were compared. There was no difference on in-hospital mortality on subgroup analyses between elective versus emergent surgery in the ESRD population (25.4% vs 31.1%, P = .133). On multivariable analysis, ESRD patients had greater odds of in-hospital mortality, and most individual complications when compared with the non-ESRD patients. In addition, the odds of in-hospital mortality and morbidity were greater in the elective ESRD group when compared with elective non-ESRD group and also in the emergent ESRD group when compared with the emergent non-ESRD group.

CONCLUSION: Given the high mortality and morbidity in both the emergent and elective setting that is associated with operative resection, we believe that, when possible, nonoperative management should be the preferred approach for acute diverticulitis in the setting of ESRD in patients older than 65 years.

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