Postdischarge outcomes of nonoperative management in complicated diverticulitis: Solution or Band-Aid?

Abstract

With the growing adoption of nonoperative management of complicated diverticulitis, its postdischarge consequences remain unclear. This study aimed to compare the readmission outcomes between operative and nonoperative management of patients with complicated diverticulitis. This is a retrospective cohort study of the 2020-2021 Nationwide Readmission Database, including adult patients (≥18 years) with acute complicated diverticulitis, defined by the presence of concomitant abscess formation, obstruction, or perforation. Patients were stratified by management approach-nonoperative management versus operative management-and followed for 6 months postdischarge. A total of 4,780 patients were identified, of which 51.2% managed nonoperatively. The mean (standard deviation) age was 63 (15), and 53.4% were females. Overall, 19.7% of the population were readmitted due to recurrence of complicated diverticulitis (nonoperative management: 33.9% vs operative management: 4.8%; P < .001), of which 75.2% required operative intervention (nonoperative management: 78.6% vs operative management: 50.0%; P < .001) up to 6 months postdischarge. On multivariable regression analysis, nonoperative management was identified as the only modifiable risk factor associated with higher adjusted odds of readmission due to recurrence of complicated diverticulitis (adjusted odds ratio, 9.382; P < .001) and the need for surgery upon subsequent readmissions (adjusted odds ratio, 3.024; P < .001) up to 6 months postdischarge. Nationwide, more than half of hospitalized patients with complicated diverticulitis undergo nonoperative management. However, these patients face a 9-fold higher risk-adjusted odds of readmission due to recurrence and are 3 times as likely to require surgery upon readmission. These findings highlight the importance of considering operative intervention during index admission in patients with complicated diverticulitis.