Risks Of Recurrence And Emergency Surgery Following Non-operative Treatment Of Colonic Diverticulitis: A Population-based Competing Risk Analysis
Debbie Li*, Charles de Mestral, Nancy N Baxter, Robin S McLeod, Rahim Moineddin*, Avery B Nathens
University of Toronto, Toronto, ON, Canada
This study aimed to characterize the clinical course of patients with diverticulitis following initial non-operative management.
Administrative discharge data were used to identify all patients treated non-operatively at first hospitalization for diverticulitis in Ontario, Canada (2002-2012). Time-to-event analysis and Fine and Gray competing risk regression were used to characterize the risks of readmission and emergency surgery, while accounting for death and elective colectomy as competing events.
Of 18,543 patients hospitalized, 14,404 (78%) were managed non-operatively. Median age was 59 years (IQR: 48-74), median follow-up was 3.9 years (maximum 10, IQR: 1.8-6.5). Five-year cumulative incidence for readmission was 8.6% (95% CI: 8.1-9.1%) and 1.9% for emergency surgery (95% CI: 1.7-2.2%), while the cumulative incidence for death was 15.7% (95% CI: 15.0-16.5%). Patients age <50 years had higher risk of readmission (10.2% vs 8.0%, p<0.001), but not emergency surgery (1.8% vs 2.0%, p=0.565). Compared to uncomplicated diverticulitis, patients with complicated index disease (abscess, fistula, perforation) were at increased risk (readmission 11.3% vs 7.9%, emergency surgery 4.3% vs 1.3%, all p<0.001). In multivariable regression, complicated disease and number of readmissions were associated with increased risk of subsequent emergency surgery, age <50 was not (table-1).
Risks of readmission and emergency surgery are low following non-operative management of diverticulitis. This offers support for the practice of deferring colectomy for patients without persistent symptoms or multiple recurrences.
|Covariate||Adjusted Hazard Ratio for Readmission|
|Adjusted Hazard Ratio for Emergency Surgery|
|Young Age (<50 years)||1.26 (1.11-1.44)||0.85 (0.68-1.07)|
|Female Sex||1.15 (1.02-1.30)||1.22 (0.99-1.50)|
|Charlson Comorbidity Index (per 1 point increase)||0.90 (0.84-0.97)||0.91 (0.82-1.02)|
|Income (per each increase in quintile)||0.93 (0.89-0.97)||0.87 (0.81-0.93)|
|Number of Previous Admissions (time-dependent covariate)||n/a||1.82 (1.56-2.11)|
|Complicated Index Disease (abscess, fistula, perforation)||1.48 (1.27-1.72)||3.15 (2.52-3.92)|
|Percutaneous Abscess Drainage at Index Admission||1.31 (0.96-1.81)||1.37 (0.94-1.99)|
|Calendar Year of Index Admission||0.99 (0.96-1.01)||0.98 (0.94-1.01)|
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