title: Congestive heart failure and chronic obstructive pulmonary disease predict poor surgical outcomes in older adults undergoing elective diverticulitis surgery.
abstract: BACKGROUND
  Diverticulitis is a common medical condition that disproportionately affects older adults. The ideal management of recurrent diverticulitis, including the role of prophylactic colectomy, remains uncertain.
  
  
  OBJECTIVE
  This study aimed to investigate the outcomes among older patients undergoing elective surgery for diverticulitis and examine subgroups of patients with comorbid congestive heart failure and chronic obstructive pulmonary disease to determine whether outcomes in these patients are worse than in other groups.
  
  
  METHODS
  This article reports a retrospective cohort study of patients undergoing elective surgery for diverticulitis.
  
  
  METHODS
  Data were derived from the 100% Medicare Provider Analysis and Review inpatient files from 2004 to 2007.
  
  
  METHODS
  Included were 22,752 patients, age 65 years and older, with a primary diagnosis of diverticulitis that underwent elective left-colon resection, colostomy, or ileostomy.
  
  
  METHODS
  The primary outcome measure was in-hospital mortality. The secondary outcome measures were intestinal diversion rates (colostomy and ileostomy) and postoperative complications.
  
  
  RESULTS
  Overall mortality, intestinal diversion (colostomy and ileostomy), and postoperative complication rate were 1.2%, 11.3%, and 22.1%. Patients with congestive heart failure had increased odds of in-hospital mortality (OR 3.5, 95% CI 2.59-4.63), colostomy (OR 1.9, 95% CI 1.69-2.27), and all postoperative complications, including hemorrhagic (OR 1.5, 95% CI 1.01-2.11), wound (OR 1.9, 95% CI 1.50-2.39), pulmonary (OR 4.2, 95% CI 3.59-4.85), cardiac (OR 4.6, 95% CI 3.68-5.74), postoperative shock/sepsis (OR 3.2, 95% CI 2.53-4.35), renal (OR 4.1, 95% CI 3.22-5.12), and thromboembolic (OR 1.6, 95% CI 1.00-2.43) complications. Patients with chronic obstructive pulmonary disease had significantly increased odds of wound (OR 1.4, 95% CI 1.19-1.67) and pulmonary (OR 2.2, 95% CI 1.94-2.50) complications. Advancing age, congestive heart failure, and chronic obstructive pulmonary disease were significantly associated with increased morbidity and mortality.
  
  
  CONCLUSIONS
  Medicare data are limited by the potential for lack of generalizability to patients <65 years and the potential for coding errors.
  
  
  CONCLUSIONS
  Elective diverticular surgery in older patients carries substantial morbidity, especially in those patients with comorbid congestive heart failure and chronic obstructive pulmonary disease. The rate of perioperative complications that we document in this patient population may attenuate some of the expected benefit of surgery.
authors: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287, USA.
authors: Amy J
authors: AJ
authors: Sheer
authors: Jennifer E
authors: JE
authors: Heckman
authors: Eric B
authors: EB
authors: Schneider
authors: Albert W
authors: AW
authors: Wu
authors: Jodi B
authors: JB
authors: Segal
authors: Richard
authors: R
authors: Feinberg
authors: Anne O
authors: AO
authors: Lidor
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003108:Colonic Diseases / Q000150:complications / Q000601:surgery*; D004238:Diverticulitis / Q000150:complications / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome