Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
Dig Dis Sci. 2020 Sep;65(9):2644-2653. doi: 10.1007/s10620-019-06002-w. Epub 2020 Jan 3.
Obesity is a known risk factor for diverticulitis. Our objective was to examine the less investigated impact of morbid obesity (MO) on admissions and clinical course of diverticulitis in a US representative database.
We retrospectively queried the 2010-2014 Nationwide Readmission Database to compare diverticulitis hospitalizations in 48,651 MO and 841,381 non-obese patients. Outcomes of mortality, clinical course, surgical events, and readmissions were compared using multivariable and propensity-score-matched analyses.
The number of MO 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). Multivariable analysis demonstrates that MO was associated with increased mortality (adjusted odds ratio [aOR] 1.54; 95% confidence internal [CI]: 1.16, 2.05), intensive care admissions (aOR = 1.92; 95% CI: 1.61, 2.31), emergent surgery (aOR = 1.20; 95% CI: 1.11, 1.30), colectomy (aOR = 1.13; 95% CI: 1.08, 1.18), open laparotomy (aOR = 1.28; 95% CI: 1.21, 1.34), and colostomy (aOR = 1.34; 95% CI: 1.25, 1.43). Additionally, MO was associated with higher risk for multiple readmissions for diverticulitis within 30 days (aOR = 1.45; 95% CI: 1.08, 1.96) and 6 months (aOR = 1.21; 95% CI: 1.03, 1.42). A one-to-one matched propensity-score analysis confirmed our multivariable analysis findings.
Analysis of national data demonstrates an increasing trend of MO patients' admissions for diverticulitis, with a presentation at a younger age. Furthermore, MO is associated with an increased risk of adverse outcomes and readmissions of diverticulitis. Future strategies are needed to ameliorate these outcomes.
肥胖是憩室炎的已知危险因素。我们的目的是在一个美国代表性数据库中研究病态肥胖（MO）对憩室炎入院和临床病程的影响。
我们回顾性地查询了 2010-2014 年全国再入院数据库，比较了 48651 例 MO 和 841381 例非肥胖患者的憩室炎住院患者。使用多变量和倾向评分匹配分析比较死亡率、临床病程、手术事件和再入院的结果。
2010 年 MO 患者因憩室炎入院人数为 7570 人，2014 年增加至 11935 人，而因憩室炎入院的总人数减少（p=0.003）。多变量分析表明，MO 与死亡率增加相关（调整后的优势比[OR] 1.54；95%置信区间[CI]：1.16，2.05）、重症监护病房入院（OR=1.92；95%CI：1.61，2.31）、紧急手术（OR=1.20；95%CI：1.11，1.30）、结肠切除术（OR=1.13；95%CI：1.08，1.18）、剖腹手术（OR=1.28；95%CI：1.21，1.34）和结肠造口术（OR=1.34；95%CI：1.25，1.43）。此外，MO 还与 30 天内（OR=1.45；95%CI：1.08，1.96）和 6 个月内（OR=1.21；95%CI：1.03，1.42）憩室炎多次再入院的风险增加相关。1:1 匹配倾向评分分析证实了我们的多变量分析结果。
对全国数据的分析表明，MO 患者因憩室炎入院的趋势呈上升趋势，且发病年龄更小。此外，MO 与憩室炎不良结局和再入院的风险增加相关。需要制定未来的策略来改善这些结果。
