title: Surgical management of esophageal diverticulum: a review of the Nationwide Inpatient Sample database.
abstract: BACKGROUND
  Esophageal diverticulum is rare in the United States. The mainstay treatment of symptomatic esophageal diverticulum is surgical correction. Much of the available information regarding esophageal diverticulum and its surgical management has been derived from small studies and institutional reviews. Our study objective was to investigate the demographics, perioperative conditions, and predictors of outcomes after surgical treatment of acquired esophageal diverticulum using a nationally representative database.
  
  
  METHODS
  A retrospective review using the Nationwide Inpatient Sample database from 2000-2009 was performed for patients with acquired esophageal diverticulum. The patients were stratified into Zenker's diverticulum (ZD) or non-Zenker's diverticulum (NZD) subgroups. The covariates retrieved included age, gender, ethnicity, insurance type, and Charlson comorbidity index. A multivariate analysis was performed to determine the predictors of postoperative morbidity. Discharge-level weights were applied.
  
  
  RESULTS
  Overall, a total of 4253 patients met our inclusion criteria, 3197 (75%) with ZD and 1056 (25%) with NZD. In the ZD group, the mean age was 73 ± 12.3 y, and most were men (55%) and white (67%). The mean length of stay was 5.82 ± 8.08 d, and the mortality rate was 1.2%. The most common complication was septicemia or sepsis (2.0%). The black patients had higher odds of postoperative morbidity than the white patients (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.02-5.17). The risk of overall postoperative morbidity was 52% greater for women (OR 1.52, 95% CI 1.01-2.29). An increasing Charlson comorbidity index was an independent predictor of morbidity. In the NZD group, the mean age was 69 ± 13.9 y, and most were also men (51%) and white (63%). The mean length of stay was 8.13 ± 10.56 d, and the mortality rate was 1.6%. The most common complication was air leak (3.1%). The black and Hispanic patients had higher odds of postoperative morbidity than the white patients (OR 1.97, 95% CI 1.05-3.72 and OR 2.37, 95% CI 1.06-5.30, respectively). An increasing Charlson comorbidity index was an independent predictor of morbidity. Compared with laparoscopy, the risk of developing postoperative morbidity was higher with the thoracotomy procedure (OR 7.45, 95% CI 1.11-50.18).
  
  
  CONCLUSIONS
  Using a nationally representative database, our study found that female gender, black race, and the presence of comorbidities were associated with increased postoperative morbidity among patients with ZD. Among the patients with NZD, black and Hispanic patients had worse postoperative morbidity than the white patients, and the presence of comorbidities was associated with increased postoperative morbidity. Thoracotomy for the correction of NZD was associated with increased postoperative morbidity compared with the laparoscopic approach.
authors.affiliation: Howard University College of Medicine, Washington, District of Columbia 20060, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Onwugbufor
authors.forename: Augustine C
authors.initials: AC
authors.lastname: Obirieze
authors.forename: Gezzer
authors.initials: G
authors.lastname: Ortega
authors.forename: Delenya
authors.initials: D
authors.lastname: Allen
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Fullum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D004936:Diverticulum, Esophageal / Q000453:epidemiology / Q000601:surgery; D004947:Esophagus / Q000601:surgery; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D010609:Pharyngeal Muscles / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D016672:Zenker Diverticulum / Q000453:epidemiology* / Q000601:surgery*
keywords: Cricopharyngeal myotomy; Diverticulectomy; Diverticulum; Epiphrenic; Esophagus; Zenker’s