番茄社区

National data for 2010-2014 show alarming rises in hospitalizations of morbidly obese patients for diverticulitis, with presentations at younger ages, increased readmissions, and greater mortality during initial hospitalization.

Hisham Hussan, MD, and colleagues at Ohio State University in Columbus reported in that the number of morbidly obese patients admitted with diverticulitis increased annually from 7570 in 2010 to 11,935 in 2014, while the total number of patients admitted with diverticulitis decreased (P=0.003).

Morbid obesity was associated with the following elevated risks by adjusted odds ratio:

• Intensive care admission: 1.92 (95% CI 1.61- 2.31, P<0.001)
• Mortality: 1.54 (95% CI 1.16-2.05, P<0.003)
• Colostomy: 1.34 (95% CI 1.25-1.43, P<0.001)
• Open colectomy: 1.28 (95% CI: 1.21-1.34, P<0.001)
• Laparoscopic converted to open: 1.84 (1.63-2.07, P<0.001)
• Emergency surgery: 1.20 (95% CI 1.11-1.30, P<0.001)

Morbid obesity was also associated on multivariable analysis with a slightly higher risk for multiple readmissions for diverticulitis within 30 days (aOR 1.45, 95% CI 1.08-1.96, P=0.01) and 6 months (aOR 1.21, 95% CI 1.03-1.42, P=0.02).

A one-to-one matched propensity-score analysis confirmed the study's multivariable analysis findings. "Future strategies are needed to ameliorate these outcomes," the authors wrote.

While found no significant mortality difference between non-obese and obese patients despite the latter group's increased risk of diverticulitis complications and more frequent invasive interventions, in a novel finding the current study reported greater mortality at the index hospital admission.

Violeta B. Popov, MD, PhD, of NYU Langone Health in New York City, commented to 番茄社区, "This very timely and relevant study highlights the negative impact of obesity on one example of a common condition associated with increased healthcare costs. If our goal as a society is to reduce healthcare spending, then addressing obesity should be a priority."

Popov, who was not involved in the research, added that the negative impact of obesity on diverticulitis is particularly concerning "given the epidemic proportions of obesity in the U.S., with expected prevalence of 50% by 2030 and accounting for almost 20% of healthcare costs. Measures to stall this public health crisis are urgently needed."

Prevention strategies, more treatment options, and greater access to them are paramount. "To date, many of the effective therapies including weight loss medications, endoscopic methods such as intragastric balloons and endoscopic gastroplasty, and even bariatric surgery are not covered by most insurance providers," she said.

Study details

While obesity is a known risk factor for diverticulitis, the investigators' aim was to examine the less established impact of morbid obesity on admissions and clinical course of diverticulitis in a representative database. Accordingly, they undertook a 5-year retrospective query of the 2010-2014 that compared hospitalizations in 48,651 morbidly obese and 841,381 non-obese adult diverticulitis patients. "We did not test for plain obesity since this is not coded well in the database," Hussan told 番茄社区.

Mean age was 53.6 for the morbidly obese versus 60.9 for the non-obese, thus documenting a markedly earlier presentation on average. Those with morbid obesity were also more likely to have three or more comorbidities and to be low income and on Medicaid. Women accounted for 66.3% of morbidly obese diverticulitis patients versus 57.4% of their normal-weight counterparts. Median length of stay in the two groups was roughly comparable at 3.4 versus 2.9 days.

With morbid obesity reaching epidemic prevalence, it is crucial to appreciate additional risks in the obese patient presenting with specific illnesses, the authors wrote: "Interventions to reduce complications of disease, reduce morbidity and mortality, and thereby reduce healthcare costs are needed. Future research should examine efforts to reduce risk and complications of diverticulitis in obese patients and work toward elucidating optimal management in this population."

Hussan and colleagues acknowledged the intrinsic limitations of using information from a database, which lacks details on medication administration, surgical technique, and outpatient follow-up. In addition, the study was bound by the quality of ICD-9 diverticulitis coding and documentation at admission and discharge, and therefore inconsistent inclusion based on differing disease definitions could have biased results.

Furthermore, the lack of some ICD-9 codes' reliability prevented from further examination of diverticulitis outcomes. Finally, body mass index was used to define obesity using ICD-9 codes as well; BMI can be a poor predictor of obesity in that it does not account for distribution or composition of body fat.

Comment