Emergency Surgery for Diverticulitis: Does the Number of Days From Admission to Surgery Matter?

INTRODUCTION

This study evaluated the association between time from hospital admission to surgery and the use of minimally invasive surgery (MIS) and primary anastomosis in emergency surgery for acute diverticulitis.

METHODS

This was a multicenter observational study using prospectively collected American College of Surgeons National Surgical Quality Improvement Program data from 2012 to 2022. Adult patients who underwent emergency left-sided colectomy for acute diverticulitis were included. The primary exposure was the number of days from hospital admission to surgery, categorized as early (0-1 d), subacute (2-4 d), and late (≥5 d). Outcomes included an MIS approach, primary anastomosis (with or without diversion), 30-d major morbidity, return to the operating room, and mortality. Multivariate logistic regression and sensitivity analyses excluding patients with preoperative septic shock were performed.

RESULTS

Among 13,827 patients, 71.3% underwent early surgery, 18.6% underwent subacute surgery, and 10.2% underwent late surgery. Patients were similar in median age (62.0, 60.0, and 63.0 y; P = 0.17) but differed in the proportion of female sex (49.6%, 48.5%, and 54.3%; P = 0.002) and American Society of Anesthesiologists score III/IV (66.3%, 66.8%, and 73.8%; P < 0.001). The use of MIS (11.0%, 14.1%, and 17.1%; P < 0.001) and primary anastomosis (26.1%, 29.5%, and 32.4%; P < 0.001) was higher with later surgery. After adjustment, patients who had later surgery had higher odds of MIS (subacute: adjusted odds ratio [aOR] 1.26, 95% confidence interval [CI] 1.10-1.43; late: aOR 1.57, 95% CI 1.33-1.86) and primary anastomosis (subacute: aOR 1.11, 95% CI 1.01-1.22; late: aOR 1.26, 95% CI 1.11-1.44). However, 30-d postoperative major morbidity (23.6%, 27.8%, and 32.6%; P < 0.001) and mortality (3.8%, 3.3%, and 6.4%; P < 0.001) were highest among patients undergoing late surgery.

CONCLUSIONS

Delayed emergency surgery for diverticulitis was associated with higher rates of MIS and/or primary anastomosis and increased 30-d postoperative morbidity and mortality.