title: Elective surgery for diverticulitis is associated with high risk of intestinal diversion and hospital readmission in older adults.
abstract: OBJECTIVE
  This study seeks to compare outcomes (in-hospital mortality, colostomy rates, and 30-day readmission rates) in older adult patients undergoing emergency/urgent versus elective surgery for diverticulitis.
  
  
  METHODS
  Data were derived from the 100% Medicare Provider Analysis and Review (MEDPAR) inpatient file from 2004-2007. All patients 65 years of age and above with a primary diagnosis of diverticulitis that underwent left colon resection, colostomy, or ileostomy were included. The primary outcome variable was in-hospital mortality. Secondary outcome variables included intestinal diversion, 30-day post-discharge readmission rates, discharge destination, length of stay, and total charges. Patients were grouped in two categories for comparison: emergent/urgent (EU) versus elective surgery, as defined by admission type. Multivariate analysis was performed adjusting for age (categorized by five groups), gender, race, and medical comorbidity as measured by Charlson Index.
  
  
  RESULTS
  Fifty-three thousand three hundred sixteen individuals were eligible for inclusion, with 23,764 (44.6%) in the elective group. On average, EU patients were older (76.8 vs. 73.9 years of age, p < 0.001) and less likely to be female (65.4% vs. 71.1%, p < 0.001). EU patients had higher in-hospital mortality (8.0% vs. 1.4%, p < 0.001), higher intestinal diversion rates (64.2% vs. 12.7%, p < 0.001), and higher 30-day readmission rates (21.4% vs. 11.9%, p < 0.001) and the worse outcomes persisted even after adjustment for risk factors. Unadjusted and adjusted mortality rates dramatically increased by age, although the affect of age on mortality was more pronounced in the elective group where mortality rates ranged from 0.56% in patients 65-69 years old to 6.5% in patients 85+ years old. The rates of ostomy and 30-day readmission generally increased with age, with worse outcomes noted particularly in the elective group.
  
  
  CONCLUSIONS
  As expected, older adults undergoing emergent/urgent surgical treatment for diverticulitis have significantly increased risks of poor outcomes compared with elective patients. While advancing age is associated with a substantial increase in mortality, intestinal diversion and 30-day readmission after surgery for diverticulitis, this affect is especially evident among patients undergoing elective colectomy. Our data suggest that given the considerable risk of prophylactic colon resection in elderly patients with sigmoid diverticulitis, a reappraisal of the proper role of elective colectomy in this population may be warranted.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 610, Baltimore, MD 21287, USA. alidor1@jhmi.edu
authors.forename: Anne O
authors.initials: AO
authors.lastname: Lidor
authors.forename: Eric
authors.initials: E
authors.lastname: Schneider
authors.forename: Jodi
authors.initials: J
authors.lastname: Segal
authors.forename: Qilu
authors.initials: Q
authors.lastname: Yu
authors.forename: Richard
authors.initials: R
authors.lastname: Feinberg
authors.forename: Albert W
authors.initials: AW
authors.lastname: Wu
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy / Q000706:statistics & numerical data*; D004238:Diverticulitis / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000706:statistics & numerical data*; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors