Elective Surgery for Diverticulitis is Associated with High Risk of Intestinal Diversion and Hospital Readmission in Older Adults

Lidor, Anne O.; Schneider, Eric B.; Segal, Jodi B; Yu, Qilu; Feinberg, Richard; Wu, Albert W.

doi:10.1007/s11605-010-1344-2

Cited by 54 publications

(35 citation statements)

References 35 publications

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“…64 We did not find data on the risk of colostomy following elective surgery for uncomplicated diverticulitis, but the reported risk in heterogenous study populations that included patients undergoing elective surgery for complicated or uncomplicated diverticulitis is as high as 13%. 64 In general, the risk of complications, colostomy and mortality is lower in the setting of elective compared to emergent surgery for diverticulitis. 4,8,64 It is important to note that surgery does not eliminate the risk of recurrence due to the possibility of residual or newly formed colon diverticula.…”

Section: Discussionmentioning

confidence: 87%

“…8,64 For example, in one study the odds of inpatient mortality following elective resection were 12 time greater in patients ≥ 85 years than those 65 to 69 years of age. 64 We did not find data on the risk of colostomy following elective surgery for uncomplicated diverticulitis, but the reported risk in heterogenous study populations that included patients undergoing elective surgery for complicated or uncomplicated diverticulitis is as high as 13%. 64 In general, the risk of complications, colostomy and mortality is lower in the setting of elective compared to emergent surgery for diverticulitis.…”

Section: Discussionmentioning

confidence: 99%

“…64 In general, the risk of complications, colostomy and mortality is lower in the setting of elective compared to emergent surgery for diverticulitis. 4,8,64 It is important to note that surgery does not eliminate the risk of recurrence due to the possibility of residual or newly formed colon diverticula. Surgical technique appears to play a role in the risk of M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 28 recurrence following surgery, although the literature on this issue is limited and beyond the scope of this review.…”

Section: Discussionmentioning

confidence: 99%

“…However, we identified a trial testing the use of mezalamine (1.6 g/day for 10 days/month for 12 months), lactobacillus casei (24 billion/day for 10 days/month for 12 months) or the combination against placebo in individuals with SUDD. 117 We extracted the data from the groups allocated to lactobacillus (n=55, 51% female, median age 64) and placebo (n=50, 40% female, median age 60). The results suggested that the use of lactobacillus might produce 14 fewer complications at 5 years per 1000 patients (95% CI from 33 fewer to 214 more; very-low quality evidence), 76 fewer surgeries at 5 years per 1000 patients (95% CI from 108 fewer to 686 more; very-low quality of evidence) and 313 fewer patients with abdominal pain at 1…”

Section: Effect Estimatesmentioning

confidence: 99%

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American Gastroenterological Association Institute Technical Review on the Management of Acute Diverticulitis

2015

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Effect Estimatesmentioning

confidence: 99%

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American Gastroenterological Association Institute Technical Review on the Management of Acute Diverticulitis

2015

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“…Additionally, in-hospital mortality was higher in emergently treated patients (8 % vs. 1.4 %), and in particular those older than 85 years (15 %). In fact, emergently treated patients older than 85 years had a 5-times increased risk of mortality compared with 65-to 69-year-old patients [ 39 ].…”

Section: Diverticulosis/diverticulitismentioning

confidence: 96%

Considerations for Geriatric Patients Undergoing Colorectal Surgery

Kasten

Francone

2016

The ASCRS Textbook of Colon and Rectal Surgery

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Key Concepts• The geriatric population is diverse, with varying levels of health status including physiologic reserve and cognitive function. As such, chronological age is a poor marker of functional, physical, and cognitive decline in the elderly.• Fit elderly patients, those without signifi cant comorbidities or cognitive decline, can be managed similar to that of younger patients. Frail patients are associated with higher morbidity and mortality in both elective and emergent operations.• Elderly patients undergoing emergent procedures are at high risk (17-31 %) for post-operative mortality.• Minimally invasive surgery is safe and appropriate in the elderly population, allowing them to benefi t from decreased post-operative morbidity, faster return of bowel function, decreased length of stay, and less pain.• While some assessment models identify age as an independent risk factor for adverse outcomes, a focus on chronologic age substantially limits effective management of the geriatric patient.• Frailty is used to represent a global limited reserve in the elder population. As such, abnormalities in frailty domains are a potentially useful tool for predicting poor outcomes.

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National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults

Wang,

Leo-Summers,

Vander Wyk

et al. 2024

JAMA Netw Open

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ImportanceNationally representative estimates of hospital readmissions within 30 and 180 days after major surgery, including both fee-for-service and Medicare Advantage beneficiaries, are lacking.ObjectivesTo provide population-based estimates of hospital readmission within 30 and 180 days after major surgery in community-living older US residents and examine whether these estimates differ according to key demographic, surgical, and geriatric characteristics.Design, Setting, and ParticipantsA prospective longitudinal cohort study of National Health and Aging Trends Study data (calendar years 2011-2018), linked to records from the Centers for Medicare &amp; Medicaid Services (CMS). Data analysis was conducted from April to August 2023. Participants included community-living US residents of the contiguous US aged 65 years or older who had at least 1 major surgery from 2011 to 2018. Data analysis was conducted from April 10 to August 28, 2023.Main Outcomes and MeasuresMajor operations and hospital readmissions within 30 and 180 days were identified through data linkages with CMS files that included both fee-for-service and Medicare Advantage beneficiaries. Data on frailty and dementia were obtained from the annual National Health and Aging Trends Study assessments.ResultsA total of 1780 major operations (representing 9 556 171 survey-weighted operations nationally) were identified from 1477 community-living participants; mean (SD) age was 79.5 (7.0) years, with 56% being female. The weighted rates of hospital readmission were 11.6% (95% CI, 9.8%-13.6%) for 30 days and 27.6% (95% CI, 24.7%-30.7%) for 180 days. The highest readmission rates within 180 days were observed among participants aged 90 years or older (36.8%; 95% CI, 28.3%-46.3%), those undergoing vascular surgery (45.8%; 95% CI, 37.7%-54.1%), and persons with frailty (36.9%; 95% CI, 30.8%-43.5%) or probable dementia (39.0%; 95% CI, 30.7%-48.1%). In age- and sex-adjusted models with death as a competing risk, the hazard ratios for hospital readmission within 180 days were 2.29 (95% CI, 1.70-3.09) for frailty and 1.58 (95% CI, 1.15-2.18) for probable dementia.Conclusions and RelevanceIn this nationally representative cohort study of community-living older US residents, the likelihood of hospital readmissions within 180 days after major surgery was increased among older persons who were frail or had probable dementia, highlighting the potential value of these geriatric conditions in identifying those at increased risk.

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Elective Surgery for Diverticulitis is Associated with High Risk of Intestinal Diversion and Hospital Readmission in Older Adults

Cited by 54 publications

References 35 publications

American Gastroenterological Association Institute Technical Review on the Management of Acute Diverticulitis

American Gastroenterological Association Institute Technical Review on the Management of Acute Diverticulitis

Considerations for Geriatric Patients Undergoing Colorectal Surgery

National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults

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