Colonic resection and stoma formation due to chronic diverticular disease: nationwide population-based cohort study

Consensus on patient selection for elective colonic resection in patients with chronic diverticular disease is lacking. Early identification of patients who require surgery eventually enables timely elective resection, which could decrease the chronic diverticular disease burden. This register-based nationwide cohort study aimed to investigate the incidence of emergency and elective colonic resections or stoma formation in patients with chronic diverticular disease and explore predictors for surgery.

The study included all patients with chronic diverticular disease in Denmark from 1996 to 2020, defined as patients with two or more hospital contacts due to diverticular disease. The incidence of surgery due to chronic diverticular disease was calculated as cumulative incidence proportions. Predictors for surgery were explored in a Cox proportional hazard model.

A total of 33 951 patients with chronic diverticular disease were included. The overall 5-year cumulative incidence proportion of surgery was 13.9% (elective surgery 9.8%, emergency surgery 4.2%). Patients with complicated chronic diverticular disease, including fistula, stenosis or perforation, had a three- to six-fold higher incidence of surgery overall than patients with uncomplicated chronic diverticular disease. The incidence of elective surgery decreased with age and co-morbidity and increased with the number of emergency admissions, even more pronounced if the emergency admissions accumulated within a shorter interval.

Patients with chronic diverticular disease should be considered for elective colonic resection if they have complicated disease or several hospital contacts as they are likely to undergo surgery eventually.