217 Post Colonoscopy Diverticulitis: How Common Is It?

Abstract

INTRODUCTION: Acute Diverticulitis (AD) is a common cause of hospitalization. Colonoscopy is a commonly performed outpatient procedure. There is limited data exist regarding post colonoscopy AD. There are few single center studies which discuss about post colonoscopy AD but larger studies are lacking. Our aim is to evaluate incidence, demographic factors, clinical factors and mortality associated with post colonoscopy AD in nationwide patient population. METHODS: We used Nationwide Readmissions Database (NRD) of year 2014 to find patients admitted with AD. From that sample, we found patients who had underwent colonoscopy between one and four days prior to admission. AD patients with and without prior colonoscopy were compared by univariate and multivariate analysis. Chi-square or fisher's exact test was done for categorical variables while t test was used for continuous outcome. Multivariate logistic regression was done to compare in hospital mortality between two groups. RESULTS: There are total 235847 weighted admissions in year 2014 with AD out of which 797 (0.3%) patients had underwent colonoscopy between one and four days prior to admission. Univariate analysis showed that patients who are male and with age above 65 were significantly more associated with post colonoscopy AD. It also showed that patients with post colonoscopy AD had significantly higher mortality and total hospitalization charges (Table 1). In Multivariate analysis, patients with liver disease (Odds Ratio 1.5, P 0.02), kidney disease or electrolytes abnormalities (Odds Ratio 3.9, P < 0.0001), age more than 65 (Odds Ratio 22, P < 0.0001), and those who had recent weight loss (Odds Ratio 3.8, P < 0.001) had higher in hospital mortality while obese patients (Odds Ratio 0.7, P 0.008) had significantly lower in hospital mortality. CONCLUSION: Incidence of AD between 1 to 4 days after colonoscopy is 0.3% (3/1000) which is more commonly seen in elderly patients. Although a rare complication, possibility of AD post procedure should be kept in mind mainly for patients who already had history of AD in the past as second episode of AD can increase their morbidity and mortality significantly. Also risk stratification becomes extremely important in high risk patients such as those who are more than 65 years of age, patients with liver and kidney diseases as they will have higher in hospital mortality and higher total hospitalization charges.