176 Increased Mortality in Patients With Acute Diverticulitis and History of Inflammatory Bowel Disease

Abstract

INTRODUCTION: Patients with acute diverticulitis have a benign disease course when antibiotic treatment is provided. Risk factors for poor outcome include extensive disease, age and nutritional status. Notably, underlying background inflammation can predispose to severe disease, such as in patients with inflammatory bowel disease (IBD). The aim of this study is to compare the inpatient outcomes for patients with acute diverticulitis with and without IBD. METHODS: This was a retrospective cohort study using the 2014 National Inpatient Sample, the largest publicly available inpatient database in the United States. Inclusion criteria were age older than 18 years and a primary ICD-9 CM code for any diagnosis of acute diverticulitis. There were no exclusion criteria. The primary outcome was in-hospital mortality. The secondary outcomes were morbidity measured by intensive care unit (ICU) admission, shock, multi-organ dysfunction syndrome (MODS), malnutrition and need for partial/total colectomy, and resource utilization measured by length of hospital stay (LOS), total hospitalization charges, need for ultrasound (US), and CT abdomen. Patients with acute diverticulitis were classified as having or not IBD diagnosis using ICD-9 CM codes. Odds ratios and means were adjusted for the following confounders using multivariate regression analysis models: age, sex, race, median income in the patient's zip code, hospital region, rural location, size and hospital teaching status. RESULTS: 218,720 patients with acute diverticulitis were included in the study, from which 1,835 (0.84%) had a diagnosis of IBD. Mean age was 60.4 years and 58% of patients were female. The population was predominantly Caucasian (76.9%). The in-hospital mortality was higher among IBD patients (1.4 vs 0.4%), with an overall mortality of 0.41%. On multivariate analysis, patients with IBD had higher in-hospital mortality risk compared to patients without IBD (OR 2.77, 95% P = 0.05). When evaluating morbidity and resource utilization, only the length of stay was longer in patients with IBD 0.64 days (P = 0.024). All adjusted odds ratios, adjusted means and p values are shown in Table 1. CONCLUSION: Patients with a history of inflammatory bowel disease tended to have increased mortality after an episode of acute diverticulitis. However, no differences on morbidity and inpatient resource usage was seen in comparison to the general population.