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Higher Mortality in Surgically Managed Diverticulitis Is Associated with Asian Ethnicity and Right-Sided Disease

Choi, Christine S. M.D.; Koltun, Walter A. M.D.; Hollenbeak, Christopher S. Ph.D.

Diseases of the Colon & Rectum: March 2016 - Volume 59 - Issue 3 - p 216–223
doi: 10.1097/DCR.0000000000000526
Original Contributions: Benign

BACKGROUND: Although right-sided diverticulitis is perceived to have a higher incidence among Asians and infrequently requires surgical management in comparison with sigmoid diverticulitis, it is unknown whether differences in outcomes are due to ethnic disparity or disease pathophysiology.

OBJECTIVE: The aim of this study was to determine the surgical outcomes for Asian and non-Asian patients with diverticulitis who underwent colectomy.

DESIGN: Patients identifiable by ethnicity in the Nationwide Inpatient Sample with diverticulitis and colectomy between 2004 and 2010 were included. Univariate comparisons were made between Asian and non-Asian patients by using t tests for continuous variables and χ2 tests for categorical variables. Propensity score matching analysis was performed to compare Asian patients with otherwise similar non-Asian patients.

PATIENTS: Included were 58,142 non-Asian and 335 Asian patients with diverticulitis who underwent a colectomy.

MAIN OUTCOME MEASURES: The primary outcomes were in-hospital mortality, hospital length of stay, and total costs.

RESULTS: Asian patients were younger (56.1 vs 59.2 years, p < 0.0001), were more likely to undergo a right colectomy (22.7% vs 4.1%, p < 0.0001), and were more likely to have emergent/urgent surgery than the non-Asian patients (67.1% vs 49.8%, p < 0.0001). Without controlling for patient/disease factors, there were statistically significant differences in mortality (non-Asian 2.2% vs Asian 4.2%; p = 0.014), length of stay (non-Asian 8.9 vs Asian 9.8 days; p = 0.0166), and costs (non-Asian $18,783 vs Asian $21,901; p = 0.001). Propensity score matching comparing 333 non-Asian patients with 333 similar Asian patients showed that, whereas differences in cost and length of stay became insignificant, the difference in mortality remained statistically significant.

LIMITATIONS: The ethnicity variable was not uniformly collected by all states within the Nationwide Inpatient Sample database.

CONCLUSIONS: Among patients undergoing a colectomy for diverticulitis, a higher mortality was observed in Asian patients and right-sided disease. Future longitudinal studies comparing the natural history and outcomes of management between right- and left-sided diverticulitis are necessary to investigate whether a true ethnic disparity exists.

1 Department of Surgery, Division of Colon and Rectal Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania

2 Department Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania

Financial Disclosures: None reported.

Presented at the meeting of the Pennsylvania Society of Colon and Rectal Surgeons, Philadelphia, PA, March 13, 2015. Presented at the meeting of the American College of Surgeons Clinical Congress Conference, Chicago, IL, October 4 to 8, 2015.

Correspondence: Christine S. Choi, M.D., The Pennsylvania State University, College of Medicine, 500 University Dr, H137, Hershey, PA 17033-0850. E-mail: cchoi1@hmc.psu.edu

© 2016 The American Society of Colon and Rectal Surgeons