EP191 - Diverticulitis Trends and Patient Characteristics as Predictors of Surgical Intervention in Acute Diverticulitis in Maryland Hospitals

Purpose/Background: Acute diverticulitis is a common diagnosis leading to hospitalization and possible emergency colon surgery. While approximately 25% of acute diverticulitis patients may require surgical intervention, operative intervention has historically focused on Hartmann's procedure, but recent evidence suggests primary anastomosis is a safe alternative. While socioeconomic disparities exist in a number of conditions, it is unclear if there is a disparity in rates of surgical intervention or type of surgery in diverticulitis based on patient factors. This study aimed to evaluate patient characteristics as predictors of surgical intervention.

Methods/Interventions: The Maryland Health Services Cost Review Commission (HSCRC) data set was queried for all patients admitted to Maryland hospitals through the emergency department with diverticulitis over the calendar years of 2017-2024. Patients were grouped according to whether or not they underwent surgical intervention during the same admission and type of surgery performed. Patient specific characteristics were evaluated as they relate to surgical intervention. Multivariate logistic regression used to assess the relationship between patient characteristics and the type of management.

Results/Outcomes: Overall, 25,087 patients were included in the study. Across the state of Maryland, 11.5% of diverticulitis patients underwent surgery over the study period. Surgical management was lower in patients over 80 (OR 0.581; p=0.026) and either black (OR 0.563; p< 0.001) or other non-white patients (OR 0.653; p=0.007). Surgery rates were also lower in patients with any noncommercial insurance option (Medicare, Medicaid, or self-pay). Surgical management was more common in female patients with OR 1.109 (p=0.018) and patients with increased severity of illness (SOI) with OR 3.105 (p < 0.001). Interestingly, of all surgical cases, only SOI was predictive of lower incidence of anastomosis (OR 0.681; p< 0.001). Other patient factors such as age, race, sex, or insurance status were not associated with rates of anastomosis in operative diverticulitis cases.

Conclusion/Discussion: In the state of Maryland, SOI is most closely associated with both rates of surgery and rates of anastomosis in diverticulitis patients. However, older patients, male patients, black or other nonwhite patients, and those with noncommercial insurances are significantly less likely to undergo operative intervention, though these do not appear to contribute to whether surgical patients in these demographics undergo Hartmann's vs anastomosis. Further study is warranted to elucidate the root causes of these disparities, particularly in the realm of surgical vs. nonoperative management of acute diverticulitis.

Multivariable Logistic Regression: Patient Characteristics as Predictors of Surgery
Using multivariable logistic regression to evaluate the association between patient characteristics and surgical intervention for acute diverticulitis with reported odds ratios.
Multivariable Logistic Regression: Patient Characteristics as Predictors of Anastomosis
Using multivariable logistic regression to evaluate the association between patient characteristics and primary anastomosis for acute diverticulitis with reported odds ratios.