Acute Colonic Diverticulitis and Cirrhosis: Outcomes of Laparoscopic Colectomy Compared to an Open Approach.

BACKGROUND: The impact of cirrhosis on outcomes of acute colonic diverticulitis (ACD) has been studied infrequently. We investigated the effect of cirrhosis on outcomes of surgical patients with ACD treated either by an open or laparoscopic approach.

MATERIALS AND METHODS: A cross-sectional study was performed using the Nationwide Inpatient Sample (NIS) 2012-2014. Patients with ACD were stratified into Cirrhotics [compensated (CC) and decompensated (DC)] for comparisons of demographics, hospital length of stay (HLOS), complications, mortality, and cost. Groups were stratified according to surgical treatment: open colectomy (OC), and laparoscopic colectomy (LC). A comparative effectiveness analyses of outcomes was performed between the two surgical treatments. Univariate comparisons between groups and multivariate regression analysis were performed to identify risk factors for mortality and specific complications.

RESULTS: Out of 1,172,875 patients hospitalized with the diagnosis of ACD during the study period, 1,145 were cirrhotic. The majority were male (59%). There were 660 CC patients and 485 DC patients and all underwent either open (n=875) or laparoscopic colectomy (n=270). Consistently, a marked increase in mortality, HLOS, and cost was observed in DC regardless of the type of treatment. LC was accompanied by shorter HLOS, lower costs, and significantly decreased mortality rate when compared to OC in CC and DC.

CONCLUSIONS: The presence of cirrhosis markedly impacts outcomes in patients with ACD, leading to prolonged hospitalization, higher cost and increased complications and deaths. LC is associated with better outcomes in patients requiring surgical management, including those with decompensated cirrhosis.