EP764 - Where Are We Now? Emergency Colectomy for Diverticulitis in the Wake of the COVID-19 Pandemic

Monday, May 12, 2025

1:58 PM – 2:03 PM PT

ePoster Presenter(s)

Benjamin Gallant, MD

Resident
UMass Chan Medical School
Leicester, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Andrew Hu, MD

Mark Kusek Colorectal Research Fellow
UMass Chan Medical School
Worcester, MA, United States

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This individual has no financial relationships with ineligible companies.
HH

HyukJoo Hwang, n/a

Medical Student
University of Massachusetts Chan Medical School
Shrewsbury, Massachusetts, United States

Disclosure information not submitted.
KO

Kaitlyn Oldewurtel, D.O.

Physician
UMass Memorial
Worcester, Massachusetts, United States

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This individual has no financial relationships with ineligible companies.
AC

Allison Crawford, MS

Biostatistician
Umass Chan Medical School
Worcester, Massachusetts, United States

Disclosure information not submitted.
Justin A. Maykel, MD (he/him/his)

Chief, Division of Colorectal Surgery
UMass Memorial Medical Center
UMass Chan Medical
Worcester, Massachusetts, United States

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This individual has no relevant relationships with ineligible companies.
TP

Thomas Peponis, MD

Colon and Rectal Surgeon, Assistant Professor of Surgery
University of Massachusetts
Worcester, Massachusetts, United States

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This individual has no financial relationships with ineligible companies.
PS

Paul R. Sturrock, MD

Assistant Professor of Surgery
UMass Memorial Medical Center
Worcester, Massachusetts, United States

Disclosure information not submitted.
Karim Alavi, MD, MPH

Colon and Rectal Surgeon
UMass Chan Medical School
Worcester, Massachusetts, United States

Disclosure information not submitted.

Senior Author(s)

TA

Tess H. Aulet, MD

Colorectal Surgeon
UMass Memorial
Worcester, Massachusetts, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Benjamin Gallant, MD: This individual has no financial relationships with ineligible companies.

Andrew Hu, MD: This individual has no financial relationships with ineligible companies.

Kaitlyn Oldewurtel, D.O.: This individual has no financial relationships with ineligible companies.

Justin A. Maykel, MD: This individual has no relevant relationships with ineligible companies.

Thomas Peponis, MD: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Diverticulitis accounts for approximately 500,000 hospital admissions annually in the United States. The COVID-19 pandemic imposed significant logistical and financial strains on hospital systems. During the pandemic, the volume of colectomies performed for diverticulitis decreased; however, studies utilizing data from the National Surgical Quality Improvement Program (NSQIP) indicate an increased severity in the clinical presentation of diverticulitis. Since the conclusion of the pandemic, published data on the trends of colectomy for diverticulitis has been limited. Our study aims to analyze trends in emergency colectomies, perioperative factors, and complications among patients with diverticulitis before, during, and after the COVID-19 pandemic.

Methods/Interventions: This retrospective cohort study queried the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for inpatients who underwent a colectomy for acute or chronic diverticulitis during the years of 2018, 2020, and 2022. We defined “Pre-COVID” as 2018, “During COVID” as 2020, and “Post-COVID” as 2022. Data are shown as number and proportion or mean and standard deviation; ANOVA was used to test for differences between means for continuous variables and Chi-square tests for the categorical variables. A multivariable model predicting emergency case status was fit using backwards selection based on variables significant (p < 0.20) in the univariate table, with variables under p=0.05 kept in the final model. All analyses were performed using SAS version 9.4.

Results/Outcomes: A total of 28,808 patients were included in our final data set. Pre-COVID colectomies included 9294 subjects, COVID colectomies included 8737 subjects, and post-COVID colectomies included 10777 subjects. The proportion of emergency cases for acute and chronic diverticulitis increased to 21% during COVID, but remained at 18% during both pre- and post-COVID (p < 0.0001). The proportion of open cases also increased during COVID 33%, compared to 31% and 30% pre- and post-COVID (p < 0.0001), respectively. In the adjusted analysis predicting emergency status for colectomy, patients were less likely to present for emergency cases after the pandemic (OR 0.88 95% CI: 0.81-.95, p = 0.001) when compared to pre-COVID, whereas during COVID, patients were more likely to present with emergency cases (OR 1.09 95% CI 1.002-1.18, p = 0.045).

Conclusion/Discussion: This study demonstrates that the rates of emergency colectomy for acute and chronic diverticulitis have returned to pre-pandemic levels. Notably, despite the increased volume of cases, a smaller proportion of patients are presenting to the hospital with an emergent indication for resection. These findings likely suggest that timely evaluation of diverticulitis may influence the progression of the disease, resulting in fewer patients requiring emergency surgery.