Comparison of Outcomes Following Surgery for Diverticulitis Among Immunocompetent and Immunosuppressed Patients

Abstract

Background

The prevalence of immunosuppressed (IS) patients is on the rise, posing unique challenges during colectomy for diverticulitis. This study compares outcomes between immunocompetent (IC) and IS patients.

Methods

We identified all patients undergoing surgery for diverticulitis between 2021 and 2022 in the National Surgical Quality Improvement Program. We measured the textbook outcome (TO), defined as absence of prolonged length of stay (LOS), mortality, major morbidity, readmission, or reoperation within 30 days. Regression analyses were used to compare outcomes between IS and IC groups, stratified by case acuity.

Results

We identified 16,679 patients, including 1102 (6.6%) IS patients. Immunosuppressed patients were more likely to present with complicated diverticulitis and preoperative sepsis and more often required urgent or emergent surgery, open surgery, or diversion. Textbook outcome was achieved less often in IS patients (37.2% vs 61.5%), and they had higher rates of major morbidity (37.7% vs 19.5%) (P < 0.001). On regression, IS patients undergoing elective surgery were less likely to achieve TO (OR 0.668 [95% CI 0.538-0.830]) and more likely to experience major morbidity (1.356 [1.065-1.726]), prolonged LOS, sepsis, or readmission. In the urgent setting, IS was associated with higher odds of major morbidity (1.595 [1.072-2.372]), readmission (1.877 [1.160-3.037]), and mortality (3.149 [1.549-6.402]). In the emergency setting, IS patients had increased odds of reoperation (1.566 [1.035-2.370]) and mortality (1.545 [1.033-2.310]).

Conclusion

Emergent or urgent surgery is associated with higher mortality in IS patients compared to IC patients. In the elective setting, IS patients have similar mortality but lower TO achievement and higher morbidity.