30-Day Readmissions and the Need for Emergent Surgery Following Nonoperative Management of Perforated Diverticulitis

Abstract

Background Limited data is available on the evaluation of patients with perforated diverticulitis who were managed without surgery and their outcomes. Aims This retrospective review was aimed at investigating the 30-day non-elective readmission rates for patients hospitalized with perforated diverticular disease who were managed without surgery, rates of patients requiring surgery on readmission and the independent predictors of readmission. Methods A total of 143, 546 patients from the National Readmission Database between 2016 to 2020 who were admitted with perforated diverticulitis and managed nonoperatively were reviewed. Readmitted patients were compared to those not readmitted. Comparisons for continuous and categorical variables were made using the student t-test and chi-squared test, respectively. A logistic regression model was used to determine independent factors associated with readmission. All analysis were done with SAS 9.4; P values < 0.05 identified significance. Results Among patients with perforated diverticulitis who were managed non-operatively, 17,868 (12.4%) were readmitted within 30 days and 4,924 (27.6%) of patients readmitted required surgical intervention. The greatest independent predictors of readmission include: patient insurance status, index length of stay, and patient disposition. Comorbidities predicting readmission include renal failure, chronic pulmonary disease, diabetes, fluid and electrolyte disorders, and hypertension. Hospital total charges were higher at the index admission for patients requiring readmission. Conclusion Nonoperative management of perforated diverticulitis is safe for many patients but the risks for readmission and subsequent need for emergent surgery require special consideration.