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Daniel A. Anaya, MD; David R. Flum, MD, MPH

Arch Surg. 2005;140:681-685.

Hypothesis  Patients with diverticulitis are at a lifetime risk for emergency colectomy and colostomy. Age and recurrence characteristics can serve to predict the risk for these adverse outcomes.

Design  Time-to-event analysis and logistic regression were used to determine the risk of emergency colectomy/colostomy.

Setting and Patients  A retrospective cohort study using a statewide administrative database and identifying all patients hospitalized nonelectively for diverticulitis (1987-2001).

Main Outcome Measure  Emergency colectomy and/or colostomy in patients treated nonsurgically after a first episode of acute diverticulitis.

Results  A total of 25 058 patients (mean age [ ± SD], 69 [16] years, 60% female) were hospitalized for an initial episode of diverticulitis. Of the 20 136 patients treated without initial operation, 19% had recurrences, with younger patients (<50 years) more likely to have a recurrence than older patients (27% vs 17%, P<.001). While only 5.5% of patients had recurrent hospitalizations during which an emergency colectomy/colostomy was performed, it occurred more commonly in younger patients (7.5% vs 5%, P<.001). The adjusted hazard ratio for emergency colectomy/colostomy in younger patients was 39% higher than in older patients (hazard ratio, 1.39; 95% confidence interval, 1.21-1.62). Among all patients, the adjusted hazard ratio for emergency colectomy/colostomy was 2.2 times higher with each subsequent admission (hazard ratio, 2.2; 95% confidence interval, 2.1-2.2). The predicted probability of emergency colectomy/colostomy was highest in younger patients with multiple rehospitalizations.

Conclusions  Age and number of recurrent events were associated with the risk of emergency colectomy/colostomy after successful nonoperative management in patients with diverticulitis. Individualization of recommendations regarding elective colectomy based on these factors may be more appropriate than the application of previously published strategies.

Author Affiliations: Departments of Surgery (Drs Anaya and Flum) and Health Services (Dr Flum), University of Washington, Seattle.

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