Author/Authors :
F. Irons Robin نويسنده Department of Surgery, Cooper University Hospital and
Cooper Medical School of Rowan University, Camden, NJ,
USA , E. Kwiatt Michael نويسنده Department of Surgery, Cooper University Hospital and
Cooper Medical School of Rowan University, Camden, NJ,
USA , J. Minarich Michael نويسنده Department of Surgery, Cooper University Hospital and
Cooper Medical School of Rowan University, Camden, NJ,
USA , P. Gaughan John نويسنده Cooper Research Institute and Cooper Medical School of
Rowan University, Camden, NJ, USA , R. Spitz Francis نويسنده Department of Surgery, Cooper University Hospital and
Cooper Medical School of Rowan University, Camden, NJ,
USA , J. McClane Steven نويسنده Department of Surgery, Cooper University Hospital and
Cooper Medical School of Rowan University, Camden, NJ,
USA
Abstract :
Background Ideal operative timing for non-emergent, acute
diverticulitis (AD) remains unclear. Medical management is initially
attempted to convert a high risk urgent surgery to a less morbid
elective surgery, or to avoid surgery altogether. A large proportion of
patients will fail medical treatment and require colectomy. Objectives
To evaluate the effect of operative delay on sepsis and mortality in
patients with AD. Methods Patients from the American College of Surgeons
National Surgical Quality Improvement Program (ACS-NSQIP) database who
underwent colectomy with a primary diagnosis of diverticulitis between
2005 and 2014 were included. Multiple patient variables were analyzed to
see their combined effect on death and sepsis. Patients undergoing
surgical intervention on hospital day 0, emergent cases and those with
preoperative sepsis were excluded. The impact of operative delay on
mortality and sepsis was evaluated using day from admission as the
predictor of the primary outcomes. Secondary outcomes included urinary
tract infection (UTI), pneumonia (PNA), need for blood transfusion,
septic shock, return to the operating room, length of stay (LOS),
readmission, wound dehiscence, and surgical site infections (SSI).
Frequency of patient variables was recorded and a multiple variable
logistic regression analysis was performed to control for possible
confounders. Odds ratios (OR) with 95% confidence intervals (CI) were
calculated for primary and secondary outcomes. Results 32,399 patients
underwent colectomy for AD on hospital day 1 - 20. Adjusted for other
factors, days to operation was found to be a significant predictor for
death (OR = 1.038, 95% CI 1.020 - 1.057; P < 0.0001) and sepsis
(OR = 1.051, 95% CI, 1.035 - 1.067; P < 0.0001). Each day in
which surgical intervention was delayed was associated with a 3.8%
increased risk of mortality and 5.1% increased risk of sepsis. Delay of
surgery was also associated with an increased risk of blood transfusion,
return to the operating room and increased LOS. Conclusions Delaying
operation for patients with AD has a significant impact on sepsis and
mortality. While non-operative approaches may be attempted, with each
additional day operative therapy is delayed there is a significant
increase in the risk of morbidity and mortality. This data suggests that
surgeons should pursue operative therapy earlier in the hospital course
to improve patient outcomes.
