Are there differences in outcome after elective sigmoidectomy for diverticular disease and for cancer? A national inpatient study

M. I M Ilyas, B. Zangbar, V. N. Nfonsam, F. A. Maegawa, B. A. Joseph, J. A. Patel, S. D. Wexner

Research output: Research - peer-reviewArticle

Abstract

Aim: The postoperative outcome after elective sigmoidectomy for diverticulitis has not been compared to that for cancer. The study aimed to evaluate the differences in the postoperative outcome after sigmoidectomy for diverticular disease and cancer. Method: The National Inpatient Sample Database was used to identify patients who underwent elective sigmoid resection for diverticular disease or cancer between 2004 and 2011. After excluding patients with metastatic cancer and preoperative weight loss, sigmoid cancer and diverticulitis patients were matched using propensity score, controlling for age, gender, race, type of operation (open vs laparoscopic) and comorbidities. The end-points of interest were infective complications, reoperation, anastomotic leakage, rebleeding, length of hospital stay and in-hospital mortality. Results: After propensity score matching (diverticulitis 11 192 patients, sigmoid cancer 11 192 patients), the mean age was 65 ± 12.5 years, 53.8% were male and 61.5% were Caucasian. Only 18.0% of the operations were done by laparoscopy. The overall complication rate was 17.7% and the in-hospital mortality rate was 0.9%. The diverticulitis group had a higher rate of surgical site infection (3.2% vs 2.6%, P = 0.004), intra-abdominal abscess formation (1.2% vs 0.4%, P < 0.0001) and reoperation (6.1% vs 4.1%, P < 0.0001) compared with the cancer group. The cancer group had a higher incidence of pneumonia (1.9% vs 1.5%, P = 0.01) and anastomotic leakage (9.2% vs 8.3%, P = 0.001). There was no difference in sepsis, deep vein thrombosis, respiratory failure, renal failure, rebleeding, overall complication rate or length of hospital stay. Subgroup analysis showed a higher in-hospital mortality for cancer than for diverticulitis patients whether resected by open or by laparoscopic surgery. Conclusion: Although elective sigmoidectomy for diverticular disease has a higher risk of infective complications, elective sigmoidectomy for cancer has a higher risk of anastomotic leakage.

LanguageEnglish (US)
Pages260-265
Number of pages6
JournalColorectal Disease
Volume19
Issue number3
DOIs
StatePublished - Mar 1 2017

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Inpatients
Neoplasms
Diverticulitis
Length of Stay
Anastomotic Leak
Hospital Mortality
Sigmoid Neoplasms
Propensity Score
Reoperation
Laparoscopy
Abdominal Abscess
Surgical Wound Infection
Sigmoid Colon
Venous Thrombosis
Respiratory Insufficiency
Renal Insufficiency
Comorbidity
Weight Loss
Sepsis
Pneumonia

Keywords

  • colon cancer
  • colorectal surgery
  • diverticulitis
  • outcomes
  • Sigmoidectomy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Are there differences in outcome after elective sigmoidectomy for diverticular disease and for cancer? A national inpatient study. / Ilyas, M. I M; Zangbar, B.; Nfonsam, V. N.; Maegawa, F. A.; Joseph, B. A.; Patel, J. A.; Wexner, S. D.

In: Colorectal Disease, Vol. 19, No. 3, 01.03.2017, p. 260-265.

Research output: Research - peer-reviewArticle

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abstract = "Aim: The postoperative outcome after elective sigmoidectomy for diverticulitis has not been compared to that for cancer. The study aimed to evaluate the differences in the postoperative outcome after sigmoidectomy for diverticular disease and cancer. Method: The National Inpatient Sample Database was used to identify patients who underwent elective sigmoid resection for diverticular disease or cancer between 2004 and 2011. After excluding patients with metastatic cancer and preoperative weight loss, sigmoid cancer and diverticulitis patients were matched using propensity score, controlling for age, gender, race, type of operation (open vs laparoscopic) and comorbidities. The end-points of interest were infective complications, reoperation, anastomotic leakage, rebleeding, length of hospital stay and in-hospital mortality. Results: After propensity score matching (diverticulitis 11 192 patients, sigmoid cancer 11 192 patients), the mean age was 65 ± 12.5 years, 53.8% were male and 61.5% were Caucasian. Only 18.0% of the operations were done by laparoscopy. The overall complication rate was 17.7% and the in-hospital mortality rate was 0.9%. The diverticulitis group had a higher rate of surgical site infection (3.2% vs 2.6%, P = 0.004), intra-abdominal abscess formation (1.2% vs 0.4%, P < 0.0001) and reoperation (6.1% vs 4.1%, P < 0.0001) compared with the cancer group. The cancer group had a higher incidence of pneumonia (1.9% vs 1.5%, P = 0.01) and anastomotic leakage (9.2% vs 8.3%, P = 0.001). There was no difference in sepsis, deep vein thrombosis, respiratory failure, renal failure, rebleeding, overall complication rate or length of hospital stay. Subgroup analysis showed a higher in-hospital mortality for cancer than for diverticulitis patients whether resected by open or by laparoscopic surgery. Conclusion: Although elective sigmoidectomy for diverticular disease has a higher risk of infective complications, elective sigmoidectomy for cancer has a higher risk of anastomotic leakage.",
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T1 - Are there differences in outcome after elective sigmoidectomy for diverticular disease and for cancer? A national inpatient study

AU - Ilyas,M. I M

AU - Zangbar,B.

AU - Nfonsam,V. N.

AU - Maegawa,F. A.

AU - Joseph,B. A.

AU - Patel,J. A.

AU - Wexner,S. D.

PY - 2017/3/1

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N2 - Aim: The postoperative outcome after elective sigmoidectomy for diverticulitis has not been compared to that for cancer. The study aimed to evaluate the differences in the postoperative outcome after sigmoidectomy for diverticular disease and cancer. Method: The National Inpatient Sample Database was used to identify patients who underwent elective sigmoid resection for diverticular disease or cancer between 2004 and 2011. After excluding patients with metastatic cancer and preoperative weight loss, sigmoid cancer and diverticulitis patients were matched using propensity score, controlling for age, gender, race, type of operation (open vs laparoscopic) and comorbidities. The end-points of interest were infective complications, reoperation, anastomotic leakage, rebleeding, length of hospital stay and in-hospital mortality. Results: After propensity score matching (diverticulitis 11 192 patients, sigmoid cancer 11 192 patients), the mean age was 65 ± 12.5 years, 53.8% were male and 61.5% were Caucasian. Only 18.0% of the operations were done by laparoscopy. The overall complication rate was 17.7% and the in-hospital mortality rate was 0.9%. The diverticulitis group had a higher rate of surgical site infection (3.2% vs 2.6%, P = 0.004), intra-abdominal abscess formation (1.2% vs 0.4%, P < 0.0001) and reoperation (6.1% vs 4.1%, P < 0.0001) compared with the cancer group. The cancer group had a higher incidence of pneumonia (1.9% vs 1.5%, P = 0.01) and anastomotic leakage (9.2% vs 8.3%, P = 0.001). There was no difference in sepsis, deep vein thrombosis, respiratory failure, renal failure, rebleeding, overall complication rate or length of hospital stay. Subgroup analysis showed a higher in-hospital mortality for cancer than for diverticulitis patients whether resected by open or by laparoscopic surgery. Conclusion: Although elective sigmoidectomy for diverticular disease has a higher risk of infective complications, elective sigmoidectomy for cancer has a higher risk of anastomotic leakage.

AB - Aim: The postoperative outcome after elective sigmoidectomy for diverticulitis has not been compared to that for cancer. The study aimed to evaluate the differences in the postoperative outcome after sigmoidectomy for diverticular disease and cancer. Method: The National Inpatient Sample Database was used to identify patients who underwent elective sigmoid resection for diverticular disease or cancer between 2004 and 2011. After excluding patients with metastatic cancer and preoperative weight loss, sigmoid cancer and diverticulitis patients were matched using propensity score, controlling for age, gender, race, type of operation (open vs laparoscopic) and comorbidities. The end-points of interest were infective complications, reoperation, anastomotic leakage, rebleeding, length of hospital stay and in-hospital mortality. Results: After propensity score matching (diverticulitis 11 192 patients, sigmoid cancer 11 192 patients), the mean age was 65 ± 12.5 years, 53.8% were male and 61.5% were Caucasian. Only 18.0% of the operations were done by laparoscopy. The overall complication rate was 17.7% and the in-hospital mortality rate was 0.9%. The diverticulitis group had a higher rate of surgical site infection (3.2% vs 2.6%, P = 0.004), intra-abdominal abscess formation (1.2% vs 0.4%, P < 0.0001) and reoperation (6.1% vs 4.1%, P < 0.0001) compared with the cancer group. The cancer group had a higher incidence of pneumonia (1.9% vs 1.5%, P = 0.01) and anastomotic leakage (9.2% vs 8.3%, P = 0.001). There was no difference in sepsis, deep vein thrombosis, respiratory failure, renal failure, rebleeding, overall complication rate or length of hospital stay. Subgroup analysis showed a higher in-hospital mortality for cancer than for diverticulitis patients whether resected by open or by laparoscopic surgery. Conclusion: Although elective sigmoidectomy for diverticular disease has a higher risk of infective complications, elective sigmoidectomy for cancer has a higher risk of anastomotic leakage.

KW - colon cancer

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