Risk of emergency colectomy and colostomy in patients with diverticular disease

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.