title: Operative management of diverticulitis in a tertiary care center.
abstract: BACKGROUND
  Diverticulitis has become a medically managed disease process; the indications and timing of surgical intervention have evolved.
  
  
  METHODS
  We retrospectively reviewed all patients who underwent surgical intervention due to diverticular disease by the Division of Colon and Rectal Surgery from 2012 to 2014.
  
  
  RESULTS
  Ninety-eight surgeries were performed. Indications included colovesicular fistula, multiple recurrences of diverticulitis, medically refractory diverticulitis, stricture, abscess, colocutaneous fistula, and colovaginal fistula. Average length of stay was 5.7 ± 5.9 days (range, 1 to 51). Eighteen patients (18%) required an ostomy. Postoperative complications occurred in 18% of patients, including anastomotic leak (3.3%), wound infection (7.1%), acute kidney injury (5.1%), and urinary tract infection (2.0%). Thirty-day readmission rate was 7.2%; unplanned 30-day reoperation rate was 3.1%. There were no deaths.
  
  
  CONCLUSIONS
  The type of patient undergoing surgery for diverticulitis has changed, with selection bias toward chronic, advanced disease due to the proliferation of medical management strategies.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Rosen
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Grace S
authors.initials: GS
authors.lastname: Hwang
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Ault
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Adrian E
authors.initials: AE
authors.lastname: Ortega
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: Kyle.Cologne@med.usc.edu.
authors.forename: Kyle G
authors.initials: KG
authors.lastname: Cologne
mesh_terms: D000038:Abscess / Q000601:surgery; D003251:Constriction, Pathologic / Q000601:surgery; D017577:Cutaneous Fistula / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014624:Vaginal Fistula / Q000601:surgery
keywords: Diverticulitis; Laparoscopy; Surgery