Accepted Manuscript A Comparison of Outcomes of Emergent, Urgent and Elective Surgical Treatment of Diverticulitis Zhobin Moghadamyeghaneh, MD, Joseph C. Carmichael, MD, Brian R. Smith, MD, Steven D. Mills, MD, Alessio Pigazzi, MD, Ninh T. Nguyen, MD, Michael J. Stamos, MD PII:

S0002-9610(15)00323-2

DOI:

10.1016/j.amjsurg.2015.04.010

Reference:

AJS 11549

To appear in:

The American Journal of Surgery

Received Date: 18 December 2014 Revised Date:

8 February 2015

Accepted Date: 17 April 2015

Please cite this article as: Moghadamyeghaneh Z, Carmichael JC, Smith BR, Mills SD, Pigazzi A, Nguyen NT, Stamos MJ, A Comparison of Outcomes of Emergent, Urgent and Elective Surgical Treatment of Diverticulitis, The American Journal of Surgery (2015), doi: 10.1016/j.amjsurg.2015.04.010. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Original Article

Treatment of Diverticulitis

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A Comparison of Outcomes of Emergent, Urgent and Elective Surgical

Zhobin Moghadamyeghaneh MD1, Joseph C. Carmichael MD1, Brian R. Smith MD1, Steven D.

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Mills MD1, Alessio Pigazzi MD1, Ninh T. Nguyen MD1, Michael J. Stamos MD1

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Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California.

Presented as an poster presentation: American College of Surgeons (ACS) clinical congress,

Correspondence:

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October28, 2014

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Michael J. Stamos MD, FACS, Professor and John E. Connolly Chair in Surgery 333 City Blvd. West Suite 1600, Orange, CA 92868, USA

Email: [email protected] Tel: (714) 456-6262, Fax: (714) 456-6377 Word Count: 2,584

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ABSTRACT: Objectives

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There is a controversy regarding the best urgent surgical treatment of colonic diverticulitis. We sought to compare outcomes of patients who underwent surgery for diverticulitis by type of the admission.

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Methods

The NSQIP databases were used to examine the clinical data of patients who underwent colorectal

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resection for diverticulitis during 2012-2013. Multivariate regression analysis was performed to identify outcomes of patients. Results

We sampled a total of 13,510 patients admitted for diverticulitis who underwent colorectal resection, of which 7.8% had emergent and 19.7% had urgent operation. Patients with perforation (AOR: 188.56,

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P 2** Chronic Obstructive Pulmonary Disease Steroid Use Renal Failure Need to Dialysis Comorbidity Diabetes Mellitus Bleeding Disorder Dyspnea Weight Loss Congestive Heart Failure Mean ±SD (Cells×109/ L) WBC* Median(Cells×109/ L) Preoperative Sepsis**** Other Factors Perforation of Colon Ascites*** Mean ±SD(minutes) Operation Length Median(minutes) Laparoscopic Surgery Surgical Technique Open Surgery Colon Resection with Anastomosis Procedure Colon Resection with Colostomy *Serum White Cell Blood Count (Cells×109/ L) ** The American Society of Anesthesiologists score more than two

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Age

Urgent Surgery (2662) 61+14 62 1432(53.8%) 2238(89.3%) 206(8.2%) 34(1.4%) 28(1.1%) 1401(52.6%) 1642(61.8%) 218(8.2%) 258(9.7%) 32(1.2%) 342(12.8%) 234(8.8%) 165(6.2%) 110(4.1%) 45(1.7%) 11.20+5.83 10 1078(40.5%) 0 28(1.1%) 149+73 134 1071(40.2%) 1591(59.8%) 1117(42%) 1545(58%)

Elective Surgery (9788) 58+12 58 5299(54.1%) 8527(91.8%) 598(6.4%) 91(1%) 68(0.7%) 4329(44.2%) 3177(32.5%) 299(3.1%) 312(3.2%) 27(0.3%) 916(9.4%) 155(1.6%) 457(4.7%) 180(1.8%) 17(0.2%) 7.57+2.69 7.10 141(1.4%) 0 6(0.1%) 183+84 170 7047(72%) 2741(28%) 9249(94.5%) 539(5.5%)

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Emergent Surgery (1060) 62+14 62 565(53.3%) 854(90.9%) 69(7.3%) 14(1.5%) 3(0.3%) 551(52%) 719(67.9%) 87(8.2%) 150(14.2%) 19(1.8%) 132(12.5%) 111(10.5%) 87(8.2%) 25(2.4%) 17(1.6%) 13.71+6.36 13.20 672(63.4%) 917(86.5%) 28(2.6%) 134+60 124 86(8.1%) 974(91.9%) 174(16.4%) 886(83.6%)

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Variables

***Presence of fluid accumulation in the peritoneal cavity noted on physical examination, abdominal ultrasound, or abdominal

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CT/MRI prior to the operation **** Systemic inflammatory response syndrome or sepsis or septic shock within 48 hours prior to surgery

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ACCEPTED MANUSCRIPT

Table 2- Risk adjusted analysis of outcomes of emergent and urgent surgical treatment compared to elective surgical treatment of diverticulitis Pvalue 0.26