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Updated: May 21, 2025
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Reoperation and mortality following elective surgery for chronic and recurrent colonic diverticular disease: A
Helene R Dalby1,2, Rune Erichsen3,4, Kaare A Gotschalck5,6
1Department of Surgery, Randers Regional Hospital, Randers, Denmark. helecl@rm.dk.
Insights
Elective surgery for chronic and recurrent diverticular disease (crDD) is safe, with declining reoperation and mortality rates over time. Early surgical intervention may benefit patients with disabling symptoms and frequent hospitalizations.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Surgical Outcomes Research
Background:
- Chronic and recurrent diverticular disease (crDD) treatment remains debated due to limited surgical safety data.
- Understanding surgical risks and predictors is crucial for optimizing crDD management.
Purpose of the Study:
- To evaluate 90-day reoperation and mortality rates after elective surgery for crDD.
- To identify predictors of reoperation and mortality in crDD patients undergoing surgery.
Main Methods:
- A national cohort study in Denmark (1996-2021) included patients with crDD undergoing elective colonic resection or stoma formation.
- Outcomes assessed were 90-day cumulative incidence proportion (CIP) of reoperation and mortality.
- Cox proportional hazard models were used to explore predictors of adverse outcomes.
Main Results:
- 10% of 35,174 crDD patients underwent elective surgery, with 90-day reoperation at 18.0% and mortality at 1.6%.
- Reoperation and mortality rates significantly declined over 25 years (reoperation by 30%, mortality by 74%).
- Anastomotic leak reoperation rate was 3.0% overall, decreasing to 0.9% in recent years. Higher hospital contact predicted reoperation, but not mortality. Mortality was significantly higher in older patients (≥80 years).
Conclusions:
- Elective surgery for crDD is safe with careful patient selection.
- The risk of reoperation due to anastomotic leak is low.
- Increased reoperation rates in patients with higher hospital contact suggest considering early elective surgery for disabling crDD.
Purpose:
The ideal treatment for chronic and recurrent colonic diverticular disease (crDD) remains unresolved, partly due to lacking evidence regarding surgical safety. This study evaluated 90-day reoperation and mortality rates following elective surgery for crDD and explored predictors for reoperation and mortality.
Methods:
This national cohort study included all patients with crDD undergoing elective colonic resection or stoma formation in Denmark from 1996-2021. Outcomes were the 90-day cumulative incidence proportion (CIP) of reoperation and mortality, and predictors were explored in Cox proportional hazard models.
Results:
Among 35,174 patients with crDD, 3,584 (10%) underwent elective surgery. The 90-day reoperation rate was 18.0%; mortality was 1.6%. During the 25-year period, the reoperation rate declined 30%, from 19.5% to 13.8%, and mortality declined 74%, from 2.7% to 0.7%. Among 2,942 patients with colonic resection and no stoma formation, the reoperation rate due to anastomotic leak was 3.0% overall and 0.9% in the most recent years. Mortality was 18 times higher in patients aged ≥ 80 years versus those aged < 60 years (CIP 8.0% versus 0.4%). The reoperation rate was increased in patients with ≥ 4 hospital contacts or ≥ 3 admissions compared to patients with fewer contacts, while mortality was not associated with the number of hospital contacts before surgery.
Conclusion:
Elective surgery in crDD was safe with careful patient selection. The risk of reoperation due to anastomotic leak was very low. Patients with most hospital contacts had an increased reoperation rate, supporting consideration for elective surgery early in patients with disabling diverticular disease.
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