The Impact of Obesity on Mortality and Clinical Outcomes in Patients with Acute Diverticulitis in the United States

Abstract

Background and Aims: Diverticular disease represents a leading cause of gastrointestinal-related hospitalizations. We sought to identify the adverse consequences of obesity on acute diverticulitis (AD) hospital admissions. By age 85, approximately two-thirds of individuals will develop diverticular disease and up to 25% will develop AD. Generally, obesity confers an increased risk of morbidity and mortality; however, its impact on hospitalized patients with AD are lacking.
 Methods: Utilizing ICD-9-CM codes from the National Inpatient Sample (January 2012 – October 2015) we identified patients with a primary discharge diagnosis of AD including 660,820 hospitalizations and 115,785 with obesity. Primary outcomes were mortality, length of stay, and hospitalization cost. Secondary outcomes were AD complications and the need for surgical interventions.
 Results: On multivariate analysis, obesity was not associated with an increased risk of mortality (OR=1.1, 95%CI: 0.87-1.41; p= 0.43). However, morbid obesity (BMI > 40 kg/m2) showed a significant increased risk of mortality (OR=1.69, 95%CI: 1.23-2.31; p<0.001). Obesity was associated with prolonged hospitalizations length of stay by 0.61 days (0.55-0.68; p <10-6), higher hospital charges $6,320 ($ 5,500-7,140; p<10-6), increased complicated diverticulitis 1.05 (1.01-1.1; p < 0.010) and required more surgical interventions for diverticulitis (OR=1.19, 95%CI: 1.15-1.23; p<10-6).
 Conclusion: Morbid obesity increases risk for mortality while obesity leads to longer hospitalization stays and greater healthcare cost as well as adverse clinical outcomes and more surgical interventions. Further interventions are required to address obesity and weight loss for patients with diverticulitis to improve clinical outcomes.

The impact of overweight on diverticular disease: a cross-sectional multicentre study

“…From a public health perspective, our findings are of paramount importance since overweight is a modifiable risk factor and the observed link may promote a public healthcare policy that identifies individuals with diverticulosis who have an increased risk of experiencing diverticulitis [23]. Recently, Makar et al reported that obesity led to adverse outcomes and several surgical interventions and morbid obesity led to higher mortality rates among patients with acute diverticulitis [24]. Furthermore, recent study by Koziel et al showed that among patients with established coronary artery disease, there was a gradual increase in BMI and waist circumference [25].…”

Surgeon-Performed Point-of-Care Ultrasound in the Diagnosis of Acute Sigmoid Diverticulitis: A Pragmatic Prospective Multicenter Cohort Study

“…A further issue is that the radiologists reporting on the CTs were all generalists while, ideally, specialist radiologists with similar expertise would have provided reports on the reference values. It could be argued that the actual patient diverticulitis population is not accurately reflected in this study as we excluded obese patients from this study because high-density fat is a limitation to sonographic detection of distinguishable features while obesity is an associated factor for acute diverticulitis [49]. The outcomes in our study reflect a real-world working environment since the scans were carried out by frontline surgeons, either in-training or experienced surgeons on duty, and the post-hoc power of 85% increases our confidence that the results of our study are scalable worldwide.…”