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Session:: ePosters-Sun800-M8: Benign Abdominal

EP341 - Is 60-days the Sweet Spot: Optimal Timing for Surgical Treatment of Diverticulitis-Related Colovesical Fistulas to Prevent Infectious Morbidity

Sunday, May 10, 2026
9:05 AM - 9:10 AM ET

    ePoster Presenter(s)

  • Sheldon Gong, MD

    Resident
    Huntington Hospital
    Huntington Hospital
    Pasadena, CA, United States

    Disclosure information not submitted.

    View ePoster

    • Author(s)

  • Jasmine Park, MD

    Resident Physician
    Huntington Hospital
    Pasadena, CA, United States

    Disclosure information not submitted.

  • GA

    Gabriel Akopian, MD, MBS

    General Surgery Residency Program Director
    Huntington Hospital
    Pasadena, California, United States

    Disclosure information not submitted.

  • Karen Zaghiyan, MD FASCRS

    Program Director, Colorectal Surgery Residency
    Cedars-Sinai Medical Center
    Cedars Sinai medical center
    Los Angeles, CA, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

    • Senior Author(s)

  • AT

    Adam Truong, MD, MS

    Attending
    Huntington Hospital
    pasadena, California, United States

    Disclosure information not submitted.

Purpose/Background: The optimal timing for surgical repair of colovesical fistulas (CVF) remains uncertain. While delayed repair allows for patient optimization, early repair may reduce urinary tract infections (UTI) risk. We aimed to characterize UTI occurrence following CVF diagnosis and hypothesized that surgery within 60 days would reduce CVF-related UTI episodes.

Methods/Interventions: We conducted a multi-institutional retrospective study of patients with CVF who underwent surgical repair at two Cedars-Sinai Network hospitals (2021-2025). Patients were identified through electronic medical record query using ICD-9 codes and CVF-related keywords. All diverticulitis-related CVFs, diagnosed both inpatient and outpatient, that underwent surgical repair were included; fistulas related to inflammatory bowel disease and malignancy were excluded. UTI after CVF diagnosis was defined as antibiotic initiation for positive urinalysis/culture or documented clinical suspicion of UTI. Time from CVF diagnosis until surgical repair was categorized as early (≤60 days) or late (>60 days). Clinical factors associated with UTI occurrence before CVF repair were analyzed with binary logistic regression and Cox proportional hazards modeling.

Results/Outcomes: Of 78 CVF patients, 66 (85%) had diverticulitis-related fistulas and all but one were left-sided. The cohort was 50% female with a median age of 70 (IQR 61-78) years body mass index of 27 (23-31) and Charlson Comorbidity Index (CCI) of 3 (2-5). Most patients (59%) had no evidence of active diverticulitis at CVF diagnosis, and the median time to surgery for all patients was 72 (41-179) days. Twenty-six patients (39%) underwent early surgery. Early patients were more frequently male (73% vs 27%, p=0.005), however race distribution, ASA score, and rates of repeat colonoscopy were similar between groups. Preoperative UTI occurred in 4 (15%) early patients compared to 31 (78%) late surgery patients (p < 0.001). Among late patients, 45% had a single UTI before surgery, 15% had 2 episodes, and 10% had 3 or more. UTI led to hospital readmission in 16 (24%) patients and urosepsis in 7 (11%). On binary logistic regression, early surgery was the only significant protective factor against UTI occurrence (OR 0.28, 95% CI 0.01-0.13, p< 0.001). On Cox analysis, higher CCI was associated with increased UTI risk (HR 1.22, 95% CI 1.02-1.46, p=0.03) as was "other" race (HR 12.31, 95% CI 2.61-58.05, p=0.02). Cumulative hazard is shown in FIGURE.

Ureteral stents were used more often in later surgery (87% vs 67%), with higher rates of stent complications (11% vs 6%, p=0.04). 30-day complications occurred in 23% of patients overall, without significant difference between groups (TABLE). Deep-space infection occurred in 12% of early patients and 0% of late patients (p=0.06) and anastomotic leak in 9% vs 2% (p=0.30), respectively.

Conclusion/Discussion: Early surgical repair of diverticulitis-related CVF (≤60 days from diagnosis) was associated with a significantly lower risk of preoperative UTI and related hospital readmissions, without an increase in overall postoperative complications. These findings support early operative intervention as a strategy to reduce infection-related morbidity in patients with CVF, particularly those at higher risk of recurrent UTI or readmission. To our knowledge, this is the first study to directly examine the relationship between surgical timing and preoperative UTI development.

Cumulative Hazard Function for Different Surgical Timing
Caption: Cumulative hazard for development of UTI or Surgery (censor) between early surgery and later surgery.
30-day Complications in Patients Undergoing Early Surgery and Late Surgery