EP703 - Delayed Elective Surgery for Diverticulitis Does Not Increase Operative Complexity or Mortality: An Analysis Across Practice Periods

Purpose/Background: In 2014, the American Society of Colon and Rectal surgeons (ASCRS) shifted recommendations for elective colectomy in diverticulitis from recurrence-based thresholds to an individualized, symptom-driven approach. This study aims to assess whether selective timing has influenced operative complexity and short-term outcomes in a national cohort.

Methods/Interventions: The American College of Surgeons National Surgical Quality Improvement Program database (2005-2022) was queried for patients undergoing elective colectomy for diverticulitis, identified using ICD-9/10 and CPT codes. Patients were stratified into pre-guideline (2005-2013) and post-guideline (2014-2022) eras. Primary outcomes were 30-day mortality and operative time (a surrogate for complexity). Secondary outcomes included reoperation and deep surgical site infection (SSI). Multivariable logistic regression was used to assess the independent effect of guideline era on mortality and operative complexity.

Results/Outcomes: A total of 128,630 elective colectomies were analyzed (34,899 pre-guideline; 93,731 post-guideline). Post-guideline patients were slightly older (58.8 ± 13.0 vs 58.4 ± 13.1 years, p< 0.001) and had a higher BMI (30.3 ± 6.7 vs 29.3 ± 6.5 kg/m², p< 0.001) (Table 1). Compared with the pre-guideline era, the post-guideline era demonstrated longer operative times (median 172 vs 155 minutes, p< 0.001), fewer open procedures (4.8% vs 9.3%, p< 0.001), and shorter length of stay (median 4 vs 5 days, p< 0.001), while the proportion of complex procedures remained comparable. Unadjusted 30-day mortality was unchanged (1.0% vs 1.0%, p=0.593). In adjusted analyses, the post-guideline era was not associated with mortality (OR 1.07; 95% CI 0.94-1.22; p=0.301) but was associated with lower odds of deep surgical site infection (OR 0.52; 95% CI 0.46-0.61; p< 0.001) and reoperation (OR 0.87; 95% CI 0.81-0.93; p< 0.001) (Table 2).

Conclusion/Discussion: In this analysis, individualized timing of elective colectomy for diverticulitis following the 2014 ASCRS guideline change did not increase operative complexity or mortality. Importantly, it was associated with fewer infectious complications and reoperations, supporting the safety and efficacy of symptom-driven surgical decision-making.

Baseline demographics and labs of patients undergoing treatment for diverticulitis stratified by era.
Multivariate analysis adjusted postoperative outcomes of patients undergoing treatment for diverticulitis stratified by era.