Factors Affecting Textbook Outcomes for Colectomy for Diverticular Disease

Textbook outcome (TO) is a validated quality metric that captures the most optimal surgical outcome by requiring all defined criteria to be met simultaneously. TO has been widely applied to oncologic studies, but its utility in benign disease has yet to be explored. This study aimed to identify factors influencing TO achievement in patients undergoing nonemergent colectomy for diverticular disease.

A retrospective review of the National Surgical Quality Improvement Program (2015-2022) was conducted on adult patients undergoing nonemergent colectomy for diverticular disease. TO criteria were: (1) no 30-d mortality, (2) hospital stay of ≤8 d, (3) no ostomy placement, (4) no 30-d reoperation, (5) no 30-d readmission, and (6) no adverse events.

Of 59,971 patients, 36,568 (60.9%) achieved TO. The most common reason for not achieving TO was hospital stay greater than 8 d (22.1%). On multivariate analysis, TO was significantly associated with younger age (odds ratio [OR]: 0.986, 95% confidence interval [CI]: 0.985-0.988, P < 0.0001). Black patients were less likely to achieve TO compared to White patients (OR: 0.618, 95% CI: 0.571-0.668), though this finding should be interpreted in the context of the limitations of the dataset. Lower American Society of Anesthesiologists physical status classification and nonsmoking history (OR: 0.664, 95% CI: 0.630-0.699, P < 0.0001) were associated with TO, as were mechanical bowel preparation (OR: 2.8, 95% CI: 2.659-2.95, P < 0.0001) and oral antibiotic preparation (OR: 1.868, 95% CI: 1.777-1.964, P < 0.0001).

A significant proportion of patients undergoing elective colectomy for diverticular disease do not achieve TO. Modifiable factors such as smoking cessation and preoperative bowel preparation were associated with higher TO rates. A potential disparity among Black patients was identified, warranting further intervention to understand contributors to this finding.