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Diverticulitis in Morbidly Obese Adults: A Rise in Hospitalizations with Worse Outcomes According to National US Data

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Abstract

Background and Aims

Obesity is a known risk factor for diverticulitis. Our objective was to examine the less investigated impact of morbid obesity (MO) on admissions and clinical course of diverticulitis in a US representative database.

Methods

We retrospectively queried the 2010–2014 Nationwide Readmission Database to compare diverticulitis hospitalizations in 48,651 MO and 841,381 non-obese patients. Outcomes of mortality, clinical course, surgical events, and readmissions were compared using multivariable and propensity-score-matched analyses.

Results

The number of MO patients admitted with diverticulitis increased annually from 7570 in 2010 to 11,935 in 2014, while the total number of patients admitted with diverticulitis decreased (p = 0.003). Multivariable analysis demonstrates that MO was associated with increased mortality (adjusted odds ratio [aOR] 1.54; 95% confidence internal [CI]: 1.16, 2.05), intensive care admissions (aOR = 1.92; 95% CI: 1.61, 2.31), emergent surgery (aOR = 1.20; 95% CI: 1.11, 1.30), colectomy (aOR = 1.13; 95% CI: 1.08, 1.18), open laparotomy (aOR = 1.28; 95% CI: 1.21, 1.34), and colostomy (aOR = 1.34; 95% CI: 1.25, 1.43). Additionally, MO was associated with higher risk for multiple readmissions for diverticulitis within 30 days (aOR = 1.45; 95% CI: 1.08, 1.96) and 6 months (aOR = 1.21; 95% CI: 1.03, 1.42). A one-to-one matched propensity-score analysis confirmed our multivariable analysis findings.

Conclusions

Analysis of national data demonstrates an increasing trend of MO patients’ admissions for diverticulitis, with a presentation at a younger age. Furthermore, MO is associated with an increased risk of adverse outcomes and readmissions of diverticulitis. Future strategies are needed to ameliorate these outcomes.

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Abbreviations

aOR:

Adjusted odds ratios

AHRQ:

Agency for Healthcare Research and Quality

BMI:

Body mass index

CI:

Confidence intervals

HCUP:

Healthcare cost utilization project

ICU:

Intensive care unit

IQR:

Interquartile range

MO:

Morbid obesity

ICD-9-CM:

International classification of diseases, ninth revision, clinical modification

NRD:

Nationwide readmission database

OR:

Odds ratios

SE:

Standard error

SID:

State inpatient databases

US:

United States

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Authors and Affiliations

  1. Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

    Kishan Patel

  2. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

    Kishan Patel, Somashekar G. Krishna, Peter P. Stanich, Khalid Mumtaz, Darwin L. Conwell & Hisham Hussan

  3. Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA

    Kyle Porter

  4. Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

    Steven K. Clinton

  5. The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Darwin L. Conwell, Steven K. Clinton & Hisham Hussan

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  1. Kishan Patel
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Patel, K., Krishna, S.G., Porter, K. et al. Diverticulitis in Morbidly Obese Adults: A Rise in Hospitalizations with Worse Outcomes According to National US Data. Dig Dis Sci 65, 2644–2653 (2020). https://doi.org/10.1007/s10620-019-06002-w

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