title: Are there differences in outcome after elective sigmoidectomy for diverticular disease and for cancer? A national inpatient study.
abstract: OBJECTIVE
  The postoperative outcome after elective sigmoidectomy for diverticulitis has not been compared to that for cancer. The study aimed to evaluate the differences in the postoperative outcome after sigmoidectomy for diverticular disease and cancer.
  
  
  METHODS
  The National Inpatient Sample Database was used to identify patients who underwent elective sigmoid resection for diverticular disease or cancer between 2004 and 2011. After excluding patients with metastatic cancer and preoperative weight loss, sigmoid cancer and diverticulitis patients were matched using propensity score, controlling for age, gender, race, type of operation (open vs laparoscopic) and comorbidities. The end-points of interest were infective complications, reoperation, anastomotic leakage, rebleeding, length of hospital stay and in-hospital mortality.
  
  
  RESULTS
  After propensity score matching (diverticulitis 11 192 patients, sigmoid cancer 11 192 patients), the mean age was 65 ± 12.5 years, 53.8% were male and 61.5% were Caucasian. Only 18.0% of the operations were done by laparoscopy. The overall complication rate was 17.7% and the in-hospital mortality rate was 0.9%. The diverticulitis group had a higher rate of surgical site infection (3.2% vs 2.6%, P = 0.004), intra-abdominal abscess formation (1.2% vs 0.4%, P < 0.0001) and reoperation (6.1% vs 4.1%, P < 0.0001) compared with the cancer group. The cancer group had a higher incidence of pneumonia (1.9% vs 1.5%, P = 0.01) and anastomotic leakage (9.2% vs 8.3%, P = 0.001). There was no difference in sepsis, deep vein thrombosis, respiratory failure, renal failure, rebleeding, overall complication rate or length of hospital stay. Subgroup analysis showed a higher in-hospital mortality for cancer than for diverticulitis patients whether resected by open or by laparoscopic surgery.
  
  
  CONCLUSIONS
  Although elective sigmoidectomy for diverticular disease has a higher risk of infective complications, elective sigmoidectomy for cancer has a higher risk of anastomotic leakage.
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona, USA.
authors.forename: M I M
authors.initials: MI
authors.lastname: Ilyas
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona, USA.
authors.forename: B
authors.initials: B
authors.lastname: Zangbar
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona, USA.
authors.forename: V N
authors.initials: VN
authors.lastname: Nfonsam
authors.affiliation: Department of Surgery, Southern Arizona VA Health Care System, Tucson, Arizona, USA.
authors.forename: F A
authors.initials: FA
authors.lastname: Maegawa
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Joseph
authors.affiliation: Department of Colorectal Surgery, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Patel
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology; D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology; D003082:Colectomy; D012809:Colon, Sigmoid / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012810:Sigmoid Diseases / Q000601:surgery*; D012811:Sigmoid Neoplasms / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology
keywords: Sigmoidectomy; colon cancer; colorectal surgery; diverticulitis; outcomes