EP2036 - Who Undergoes Surgery More Frequently? Assessment of Diverticulitis Management in Young vs. Old Patients

Purpose/Background: Historically, it was thought that diverticulitis was a more aggressive disease in young patients and thus managed with earlier elective surgery compared to older patients. However, more recently, this has come into question. Despite this shift in understanding, there remains a notable gap in the literature regarding contemporary, direct comparisons between young and older patient populations with diverticulitis. To address this gap, we aim to evaluate differences in operative versus non-operative management across age groups and assess pre-operative, operative, and post-operative outcomes in patients undergoing surgical intervention for diverticulitis.

Methods/Interventions: We used the HealthCare Cost and Utilization Project (HCUP) database to identify patients undergoing conservative and operative management for diverticulitis between 2016 and 2021. Young patients were defined as those < 50 years old and old patients >50. The primary outcome was the rate of operative vs. non-operative management between the two age groups. Secondary outcomes included evaluating preoperative characteristics, operative approaches, and postoperative outcomes between the two groups.

Results/Outcomes: A total of 219,121 patients were identified, of which 38,760 young patients were included. Young patients were more often male and had lower proportions with a Charlson Comorbidity Index (CCI) score ≥2 compared to older patients (respectively, p< 0.001, Table 1). Younger patients underwent non-operative management more frequently than older patients (p < 0.001). Among those undergoing operative management, younger patients (n=5,549) underwent fewer emergency surgeries (49.7% vs 51.0%) and more elective surgeries compared to older patients (n=32,909, 46.3% vs 44.0%, both p< 0.001). Younger patients had a higher rate of primary anastomosis without diversion (67.9% vs 61.5%) and a lower rate of Hartmann's procedures or primary anastomosis with diversion (27.2% vs 32.6%, 5% vs 5.9%, respectively, all p< 0.001). Despite the more frequent use of primary anastomoses, younger patients experienced lower rates of anastomotic leak (10.4% vs 11.5%, p=0.03) though similar reoperation rates (16.4% vs 16.9%, p=0.3). Younger patients had a significantly shorter median length of stay compared to older patients (5 vs 7 days, p< 0.01) and lower readmission rates (8.3% vs 10.1%, p< 0.001).

Conclusion/Discussion: In this large national cohort, younger patients were more often managed conservatively when admitted with diverticulitis though a slightly higher proportion of young patients underwent a subsequent elective resection compared to older patients. Not unexpectedly, younger patients with diverticulitis demonstrated lower comorbidity burden and had more favorable perioperative and postoperative outcomes compared to older patients. These findings challenge the traditional perception of diverticulitis as a more aggressive disease in younger patients and highlight important age-related differences in disease presentation, management, and outcomes.

Table 1: Comparison of Clinical Characteristics Between Young and Old Patients with Diverticulitis
Perioperative, operative, and postoperative characteristics of young vs. old patients with diverticulitis