title: Sigmoid Colectomy for Acute Diverticulitis in Immunosuppressed vs Immunocompetent Patients: Outcomes From the ACS-NSQIP Database.
abstract: BACKGROUND
  The management of acute diverticulitis in immunosuppressed patients is increasingly debated. The appropriate timing and type of operation remains controversial.
  
  
  OBJECTIVE
  This study examines the impact of immunosuppression on mortality and morbidity following colectomies for diverticulitis in the emergency and elective settings.
  With the use of the American College of Surgeons National Surgical Quality Improvement Program database, the outcomes of immunosuppressed compared with immunocompetent patients who underwent colectomy for acute diverticulitis were compared.
  
  
  METHODS
  The multi-institutional database was queried for patients who underwent colectomy for acute diverticulitis from 2005 to 2012.
  
  
  METHODS
  The impact of immunosuppression on mortality, major morbidity, organ space infection, infectious complications, and wound dehiscence was assessed.
  
  
  RESULTS
  Of 26,987 patients, 1332 were immunosuppressed and 25,655 were immunocompetent; 4271 patients had emergency (596 immunosuppressed and 3675 immunocompetent) and 22,716 patients had elective (736 immunosuppressed and 21,980 immunocompetent) colectomies for diverticulitis. In both groups, mortality and major morbidity were significantly higher in the emergency (immunosuppressed 16% and 45%, immunocompetent 4% and 28%) compared with the elective setting (immunosuppressed 2% and 25%, immunocompetent 0.4% and 12%), p < 0.001. On multivariate regression for the emergency setting, immunosuppression significantly increased mortality (OR, 1.79; 95% CI, 1.17-2.75) and did not significantly increase morbidity. On multivariate regression for the elective setting, mortality was similar in immunosuppressed and immunocompetent groups; however, major morbidity (OR, 1.46; 95% CI, 1.17-1.83) and wound dehiscence (OR, 2.69; 95% CI, 1.63-4.42) were significantly increased in immunosuppressed compared with immunocompetent patients.
  
  
  CONCLUSIONS
  The retrospective design and standardized outcomes are based on heterogeneous data.
  
  
  CONCLUSIONS
  Emergency colectomy for diverticulitis is associated with higher mortality in immunosuppressed than in immunocompetent patients, whereas elective colectomy is associated with comparable mortality. In the elective setting, immunosuppressed compared with immunocompetent patients are at increased risk of major morbidity and wound dehiscence.
authors.affiliation: Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Khamis
authors.forename: Jad
authors.initials: J
authors.lastname: Abou Khalil
authors.forename: Marie
authors.initials: M
authors.lastname: Demian
authors.forename: Nancy
authors.initials: N
authors.lastname: Morin
authors.forename: Carol-Ann
authors.initials: CA
authors.lastname: Vasilevsky
authors.forename: Philip H
authors.initials: PH
authors.lastname: Gordon
authors.forename: Marylise
authors.initials: M
authors.lastname: Boutros
mesh_terms: D000208:Acute Disease; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D012809:Colon, Sigmoid / Q000473:pathology / Q000601:surgery; D016208:Databases, Factual; D004239:Diverticulitis, Colonic / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000601:surgery; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D008875:Middle Aged; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome