EP704 - Diverticulitis Trends and Hospital Factors Predicting Primary Anastomosis versus Hartman’s Procedure in Acute Diverticulitis in Maryland Hospitals

Purpose/Background: Diverticulitis is a common pathology and can result in the need for emergency colon surgery. While surgical management has historically been focused on Hartmann's procedure, recent literature has suggested safety of primary anastomosis with or without diverting loop ileostomy. The rates of adoption of anastomosis are not clear. We sought to explore the recent operative trends in the state of Maryland. Our hypothesis is that certain hospital characteristics may predict rates of surgical intervention and rates of primary anastomosis.

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. Hospital specific characteristics (size, case volume, presence of surgery residency, presence of fellowship, trauma center status, and LeapFrog quality rating) were used to determine whether hospital characteristics are associated with variability in rates of surgery or type of surgery performed. Multivariate logistic regression was used to assess the relationship between patient and hospital characteristics and type of surgical intervention.

Results/Outcomes: Across the state of Maryland, 25,087 patients were admitted with diverticulitis during the study period. Over this period, 11.5% of patients underwent surgery. The rate of surgical management trended up over time from a low of 10.0% in 2019 to a high of 13.2% in 2023 (x2 p=0.002). Multivariable logistic regression revealed lower rates of surgical management in hospitals with more beds (quartile 3: 203-257 beds and quartile 4: 283-1105 beds) with ORs of 0.773 (p < 0.001) and 0.837 (p=0.021) respectively. Higher rates of surgical management were seen in hospitals with surgical residency programs (OR 1.179; p=0.018). Rates of surgery trended higher in hospitals with colorectal surgery fellowship programs (OR 1.247) but failed to reach statistical significance (p=0.052). Of all patients undergoing surgery, anastomosis was performed in 26% of surgical cases over the study period. There was no significant difference in the percent of patients receiving anastomosis by fiscal year (x2 p=0.145), however, anastomosis rates increased from 2019-2021 peaking at 31.2% in 2020. Hospitals with trauma center status displayed significantly higher rates of anastomosis in surgically managed diverticulitis cases with an OR 1.508 (p < 0.001). Other hospital factors including diverticulitis volume, hospital size, and presence of fellowships, did not seem to predict rates of anastomosis.

Conclusion/Discussion: Diverticulitis is one of the most common surgical pathologies with operative and nonoperative management options. This study found that while overall rates of operative intervention increased over the study period, rates of anastomosis remained constant. Additionally, there were only small associations between hospital characteristics and rate of surgery or rates of anastomosis in surgical cases. Certain hospital characteristics such as trauma center status do appear to be associated with higher rates of anastomosis and the presence of a surgical residency seems to be associated with higher rates of operative intervention.

Multivariable Logistic Regression: Hospital Characteristics as Predictors of Surgery
Using multivariable logistic regression to evaluate the association between various hospital characteristics and rates of surgical management in acute diverticulitis with p<0.05 representing significant finding.
Multivariable Logistic Regression: Hospital Characteristics as a Predictor of Anastomosis
Using multivariable logistic regression to evaluate the association between various hospital characteristics and rates of anastomosis versus Hartman's procedure in acute diverticulitis with p<0.05 representing significant finding.