Proximal Intestinal Diversion is Associated with Increased Morbidity in Patients Undergoing Elective Colectomy for Diverticular Disease: An ACS-NSQIP Study

Kevin B. Wise, Amit Merchea, Robert R. Cima, Dorin T. Colibaseanu, Kristine M. Thomsen, Elizabeth B. Habermann

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Background: Elective colectomy for diverticular disease is common. Some patients undergo primary resection with proximal diversion in an effort to limit morbidity associated with potential anastomotic leak.

Methods: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried. All patients undergoing a single, elective resection for diverticular disease from 2005 to 2011 were analyzed. Thirty-day outcomes were reviewed. Factors predictive of undergoing diversion and the risk-adjusted odds of postoperative morbidity with and without proximal diversion were determined by multivariable logistic regression models.

Results: Fifteen thousand six hundred two patients undergoing non-emergent, elective resection were identified, of whom 348 (2.2 %) underwent proximal diversion. Variables predictive for undergoing proximal diversion included age ≥65 years, BMI ≥30, current smoking status, corticosteroid use, and serum albumin <3.0 g/dL. Multivariable analysis demonstrated that diversion was associated with significantly increased risk of surgical site infection (OR = 1.68), deep venous thrombosis (OR = 5.27), acute renal failure (OR = 5.83), sepsis or septic shock (OR = 1.75), readmission (OR = 2.57), and prolonged length of stay (OR = 3.35).

Conclusions: Proximal diversion in the setting of elective segmental colectomy for diverticular disease is uncommon. A combination of preoperative factors and intraoperative factors drives the decision for diversion. Patients who undergo diversion experience increased postoperative morbidity. Surgeons should have a low index of suspicion for postoperative complications and be prepared to mitigate their effect on the patient’s outcome.

Original languageEnglish (US)
Pages (from-to)535-542
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number3
DOIs
StatePublished - Jan 1 2015

Keywords

  • Colectomy
  • Diverticular disease
  • Diverticulitis
  • Intestinal diversion
  • NSQIP

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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