Diverticulitis in Morbidly Obese Adults: A Rise in Hospitalizations with Worse Outcomes According to National US Data.,Digestive Diseases and Sciences

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Diverticulitis in Morbidly Obese Adults: A Rise in Hospitalizations with Worse Outcomes According to National US Data.
Digestive Diseases and Sciences ( IF 2.5 ) Pub Date : 2020-01-03 , DOI: 10.1007/s10620-019-06002-w
Kishan Patel _{1,

2} , Somashekar G Krishna ₂ , Kyle Porter ₃ , Peter P Stanich ₂ , Khalid Mumtaz ₂ , Darwin L Conwell _{2,

4} , Steven K Clinton _{4,

5} , Hisham Hussan _{2,

4}

Affiliation

Background and Aims

Obesity is a known risk factor for diverticulitis. Our objective was to examine the less investigated impact of morbid obesity (MO) on admissions and clinical course of diverticulitis in a US representative database.

Methods

We retrospectively queried the 2010–2014 Nationwide Readmission Database to compare diverticulitis hospitalizations in 48,651 MO and 841,381 non-obese patients. Outcomes of mortality, clinical course, surgical events, and readmissions were compared using multivariable and propensity-score-matched analyses.

Results

The number of MO patients admitted with diverticulitis increased annually from 7570 in 2010 to 11,935 in 2014, while the total number of patients admitted with diverticulitis decreased (p = 0.003). Multivariable analysis demonstrates that MO was associated with increased mortality (adjusted odds ratio [aOR] 1.54; 95% confidence internal [CI]: 1.16, 2.05), intensive care admissions (aOR = 1.92; 95% CI: 1.61, 2.31), emergent surgery (aOR = 1.20; 95% CI: 1.11, 1.30), colectomy (aOR = 1.13; 95% CI: 1.08, 1.18), open laparotomy (aOR = 1.28; 95% CI: 1.21, 1.34), and colostomy (aOR = 1.34; 95% CI: 1.25, 1.43). Additionally, MO was associated with higher risk for multiple readmissions for diverticulitis within 30 days (aOR = 1.45; 95% CI: 1.08, 1.96) and 6 months (aOR = 1.21; 95% CI: 1.03, 1.42). A one-to-one matched propensity-score analysis confirmed our multivariable analysis findings.

Conclusions

Analysis of national data demonstrates an increasing trend of MO patients’ admissions for diverticulitis, with a presentation at a younger age. Furthermore, MO is associated with an increased risk of adverse outcomes and readmissions of diverticulitis. Future strategies are needed to ameliorate these outcomes.

中文翻译：

病态肥胖成人的憩室炎：根据美国国家数据，住院率上升，结局更差。

背景和目标

肥胖是憩室炎的已知危险因素。我们的目标是在美国代表性数据库中检查病态肥胖 (MO) 对憩室炎入院和临床病程的研究较少的影响。

方法

我们回顾性地查询了 2010-2014 年全国再入院数据库，以比较 48,651 名 MO 和 841,381 名非肥胖患者的憩室炎住院情况。使用多变量和倾向评分匹配分析比较死亡率、临床过程、手术事件和再入院的结果。

结果

因憩室炎入院的 MO 患者每年从 2010 年的 7570 人增加到 2014 年的 11,935 人，而因憩室炎入院的患者总数有所下降（p = 0.003)。多变量分析表明，MO 与死亡率增加（调整优势比 [aOR] 1.54；95% 内部置信度 [CI]：1.16, 2.05）、重症监护入院（aOR = 1.92；95% CI：1.61、2.31）、急诊相关手术 (aOR = 1.20; 95% CI: 1.11, 1.30)、结肠切除术 (aOR = 1.13; 95% CI: 1.08, 1.18)、开腹手术 (aOR = 1.28; 95% CI: 1.21, 1.34) 和结肠造口术 (aOR = 1.34；95% CI：1.25, 1.43)。此外，MO 与 30 天内（aOR = 1.45；95% CI：1.08, 1.96）和 6 个月（aOR = 1.21；95% CI：1.03, 1.42）内憩室炎多次再入院的风险较高相关。一对一匹配的倾向评分分析证实了我们的多变量分析结果。