Abstract
Background
Diverticular disease affects over half of individuals over 60, with 25% developing diverticulitis. While Hartmann’s procedure has traditionally been the standard for unstable patients, resection with primary anastomosis and diverting loop ileostomy (PADLI) is associated with higher stoma reversal rates and improved long-term outcomes. Despite evidence supporting PADLI, socioeconomic factors may influence procedural selection, contributing to persistent disparities in care.
Methods
A retrospective cohort study was conducted using the 2015-2021 National Inpatient Sample (NIS) to identify patients undergoing emergent surgery for acute diverticulitis. Patients who received left colectomy or sigmoidectomy were classified by procedure type (Hartmann’s vs PADLI) using ICD-10 codes. Demographic and socioeconomic factors were analyzed including age, sex, race, insurance type, income quartile, in-hospital mortality, length of stay, discharge disposition, and urban vs rural residency. The impact of these factors on procedure choice was assessed using multivariate logistic regression.
Results
Among 14 551 patients, 85.5% underwent Hartmann’s procedure and 14.5% received PADLI. Older age (OR 1.014/year, P < 0.001), female sex (OR 1.129, P = 0.011), white race (OR 1.128, P = 0.041), and lower income (OR 1.223, P < 0.001) were associated with higher odds of receiving Hartmann’s procedure. Private insurance reduced this likelihood (OR 0.747, P < 0.001). Primary anastomosis and diverting loop ileostomy was more common in metropolitan areas, younger patients, those with private insurance, and those discharged routinely.
Discussion
Socioeconomic disparities significantly influence surgical management of acute diverticulitis. Lower-income and publicly insured patients are more likely to undergo Hartmann’s procedure, while PADLI is more common in wealthier, urban populations. Addressing these disparities could promote more equitable care and improve patient outcomes.
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
