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Sigmoid Colectomy for Acute Diverticulitis in Immunosuppressed vs Immunocompetent Patients: Outcomes From the ACS-NSQIP Database

Al-Khamis, Ahmed M.D.; Abou Khalil, Jad M.D.; Demian, Marie M.Sc.; Morin, Nancy M.D.; Vasilevsky, Carol-Ann M.D.; Gordon, Philip H. M.D.; Boutros, Marylise M.D.

doi: 10.1097/DCR.0000000000000513
Original Contributions: Benign Colorectal Disease

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.

DESIGN 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.

PATIENTS: The multi-institutional database was queried for patients who underwent colectomy for acute diverticulitis from 2005 to 2012.

MAIN OUTCOMES MEASURES: 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.

LIMITATIONS: 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.

Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada

Supplemental digital content:http://links.lww.com/DCR/A212

Financial Disclosures: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Boston, MA, May 30 to June 3, 2015.

ACS-NSQIP and the hospitals participating in the ACS-NSQIP database are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Correspondence: Marylise Boutros, M.D., Assistant Professor of Surgery, McGill University, Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, Quebec H3T 1E2 Canada. E-mail: mboutros@jgh.mcgill.ca

© 2016 The American Society of Colon and Rectal Surgeons