Effects of diabetes mellitus in patients presenting with diverticulitis: Clinical correlations and disease characteristics in more than 1,000 patients

Kyle G. Cologne, Dimitra Skiada, Elizabeth Beale, Kenji Inaba, Anthony J. Senagore, Demetrios Demetriades

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: The epidemic increase in the incidence of diabetes mellitus (DM) worldwide represents a potential source of surgical morbidity. The impact of DM on the need for surgical management and its effect on surgical outcomes for colonic diverticulitis have not been well defined. METHODS: We investigated all DM versus non-DM patients admitted with a diagnosis of acute diverticulitis between January 1, 2003, and December 31, 2011, to a large urban safety net hospital. An administrative database search for patients with diverticulitis was divided into two groups: those with and without DM. They were retrospectively analyzed for severity of diverticulitis (Hinchey and Ambrosetti scores), mortality, length of hospital stay, need for operation, postoperative complications, and readmission rates. RESULTS: There were 1,019 admissions with acute diverticulitis, 164 (16.1%) of which had DM. DM versus non-DM patients presented with a higher Hinchey score of 3 or 4 (12.2% vs. 9.2%, p <0.001), a more severe computed tomographic Ambrosetti score (43.9% vs. 31.7%, p <0.001), older age, and significantly more comorbid conditions. There was no significant difference in the failure of nonoperative management (2.2% DM vs. 2.5% non-DM, p = 1.000), readmission, or death rates. Operated DM patients had a higher incidence of in-hospital infectious complications (28.7% vs. 8.2%, p <0.001) and a higher incidence of acute renal failure (5.5% vs. 0.7%, p <0.001). CONCLUSION: Although diabetic patients with colonic diverticulitis present at a more advanced level (as measured by Hinchey and Ambrosetti scores), the nonoperative success rate is similar to non-DM patients. Surgical management in DM patients is associated with a higher incidence of infectious complications and acute kidney injury. However, DM did not appear to increase operative mortality in surgically managed patients. These data suggest that greater attention should be placed on steps to reduce the negative impact of DM on both immune response and renal function in patients requiring surgery of colonic diverticulitis.

Original languageEnglish (US)
Pages (from-to)704-709
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

Fingerprint

Diverticulitis
Diabetes Mellitus
Colonic Diverticulitis
Incidence
Acute Kidney Injury
Mortality
Length of Stay
Safety-net Providers
Databases

Keywords

  • Acute care surgery
  • Diabetes
  • Diverticulitis
  • Nonoperative management

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Effects of diabetes mellitus in patients presenting with diverticulitis : Clinical correlations and disease characteristics in more than 1,000 patients. / Cologne, Kyle G.; Skiada, Dimitra; Beale, Elizabeth; Inaba, Kenji; Senagore, Anthony J.; Demetriades, Demetrios.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 3, 03.2014, p. 704-709.

Research output: Contribution to journalArticle

Cologne, Kyle G. ; Skiada, Dimitra ; Beale, Elizabeth ; Inaba, Kenji ; Senagore, Anthony J. ; Demetriades, Demetrios. / Effects of diabetes mellitus in patients presenting with diverticulitis : Clinical correlations and disease characteristics in more than 1,000 patients. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 3. pp. 704-709.
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abstract = "BACKGROUND: The epidemic increase in the incidence of diabetes mellitus (DM) worldwide represents a potential source of surgical morbidity. The impact of DM on the need for surgical management and its effect on surgical outcomes for colonic diverticulitis have not been well defined. METHODS: We investigated all DM versus non-DM patients admitted with a diagnosis of acute diverticulitis between January 1, 2003, and December 31, 2011, to a large urban safety net hospital. An administrative database search for patients with diverticulitis was divided into two groups: those with and without DM. They were retrospectively analyzed for severity of diverticulitis (Hinchey and Ambrosetti scores), mortality, length of hospital stay, need for operation, postoperative complications, and readmission rates. RESULTS: There were 1,019 admissions with acute diverticulitis, 164 (16.1{\%}) of which had DM. DM versus non-DM patients presented with a higher Hinchey score of 3 or 4 (12.2{\%} vs. 9.2{\%}, p <0.001), a more severe computed tomographic Ambrosetti score (43.9{\%} vs. 31.7{\%}, p <0.001), older age, and significantly more comorbid conditions. There was no significant difference in the failure of nonoperative management (2.2{\%} DM vs. 2.5{\%} non-DM, p = 1.000), readmission, or death rates. Operated DM patients had a higher incidence of in-hospital infectious complications (28.7{\%} vs. 8.2{\%}, p <0.001) and a higher incidence of acute renal failure (5.5{\%} vs. 0.7{\%}, p <0.001). CONCLUSION: Although diabetic patients with colonic diverticulitis present at a more advanced level (as measured by Hinchey and Ambrosetti scores), the nonoperative success rate is similar to non-DM patients. Surgical management in DM patients is associated with a higher incidence of infectious complications and acute kidney injury. However, DM did not appear to increase operative mortality in surgically managed patients. These data suggest that greater attention should be placed on steps to reduce the negative impact of DM on both immune response and renal function in patients requiring surgery of colonic diverticulitis.",
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T1 - Effects of diabetes mellitus in patients presenting with diverticulitis

T2 - Clinical correlations and disease characteristics in more than 1,000 patients

AU - Cologne, Kyle G.

AU - Skiada, Dimitra

AU - Beale, Elizabeth

AU - Inaba, Kenji

AU - Senagore, Anthony J.

AU - Demetriades, Demetrios

PY - 2014/3

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N2 - BACKGROUND: The epidemic increase in the incidence of diabetes mellitus (DM) worldwide represents a potential source of surgical morbidity. The impact of DM on the need for surgical management and its effect on surgical outcomes for colonic diverticulitis have not been well defined. METHODS: We investigated all DM versus non-DM patients admitted with a diagnosis of acute diverticulitis between January 1, 2003, and December 31, 2011, to a large urban safety net hospital. An administrative database search for patients with diverticulitis was divided into two groups: those with and without DM. They were retrospectively analyzed for severity of diverticulitis (Hinchey and Ambrosetti scores), mortality, length of hospital stay, need for operation, postoperative complications, and readmission rates. RESULTS: There were 1,019 admissions with acute diverticulitis, 164 (16.1%) of which had DM. DM versus non-DM patients presented with a higher Hinchey score of 3 or 4 (12.2% vs. 9.2%, p <0.001), a more severe computed tomographic Ambrosetti score (43.9% vs. 31.7%, p <0.001), older age, and significantly more comorbid conditions. There was no significant difference in the failure of nonoperative management (2.2% DM vs. 2.5% non-DM, p = 1.000), readmission, or death rates. Operated DM patients had a higher incidence of in-hospital infectious complications (28.7% vs. 8.2%, p <0.001) and a higher incidence of acute renal failure (5.5% vs. 0.7%, p <0.001). CONCLUSION: Although diabetic patients with colonic diverticulitis present at a more advanced level (as measured by Hinchey and Ambrosetti scores), the nonoperative success rate is similar to non-DM patients. Surgical management in DM patients is associated with a higher incidence of infectious complications and acute kidney injury. However, DM did not appear to increase operative mortality in surgically managed patients. These data suggest that greater attention should be placed on steps to reduce the negative impact of DM on both immune response and renal function in patients requiring surgery of colonic diverticulitis.

AB - BACKGROUND: The epidemic increase in the incidence of diabetes mellitus (DM) worldwide represents a potential source of surgical morbidity. The impact of DM on the need for surgical management and its effect on surgical outcomes for colonic diverticulitis have not been well defined. METHODS: We investigated all DM versus non-DM patients admitted with a diagnosis of acute diverticulitis between January 1, 2003, and December 31, 2011, to a large urban safety net hospital. An administrative database search for patients with diverticulitis was divided into two groups: those with and without DM. They were retrospectively analyzed for severity of diverticulitis (Hinchey and Ambrosetti scores), mortality, length of hospital stay, need for operation, postoperative complications, and readmission rates. RESULTS: There were 1,019 admissions with acute diverticulitis, 164 (16.1%) of which had DM. DM versus non-DM patients presented with a higher Hinchey score of 3 or 4 (12.2% vs. 9.2%, p <0.001), a more severe computed tomographic Ambrosetti score (43.9% vs. 31.7%, p <0.001), older age, and significantly more comorbid conditions. There was no significant difference in the failure of nonoperative management (2.2% DM vs. 2.5% non-DM, p = 1.000), readmission, or death rates. Operated DM patients had a higher incidence of in-hospital infectious complications (28.7% vs. 8.2%, p <0.001) and a higher incidence of acute renal failure (5.5% vs. 0.7%, p <0.001). CONCLUSION: Although diabetic patients with colonic diverticulitis present at a more advanced level (as measured by Hinchey and Ambrosetti scores), the nonoperative success rate is similar to non-DM patients. Surgical management in DM patients is associated with a higher incidence of infectious complications and acute kidney injury. However, DM did not appear to increase operative mortality in surgically managed patients. These data suggest that greater attention should be placed on steps to reduce the negative impact of DM on both immune response and renal function in patients requiring surgery of colonic diverticulitis.

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KW - Diabetes

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