The number of morbidly obese (MO) patients in the United States admitted with diverticulitis increased annually from 7570 in 2010 to nearly 12 000 in 2014-this even though the total number of patients admitted with diverticulitis decreased over the same time.
Findings were reported online January 3, 2020 in Digestive Diseases and Sciences.
The 5-year retrospective analysis of the 2010-2014 Nationwide Readmission Database was conducted by Hisham Hussan, MD, and colleagues of Ohio State University in Columbus. Noting that obesity is a known risk factor for diverticulitis, the authors described their interest in the “less investigated” effect of MO on hospital admissions and the clinical course of diverticulitis in a US representative sample.
Their analysis compared diverticulitis hospitalizations in 48 651 MO and 841 381 non-obese patients. Mean age for MO 53.6 years vs 60.9 for the non-obese. Those with MO were more likely to have ≥3 comorbidities; women accounted for 66.3% of MO patients with diverticulitis vs 57.4% of the non-obese. Median hospital stay was comparable between groups (3.4 vs 2.9 days).
Multivariable and propensity-score-matched analyses were used to compare outcomes of mortality, clinical course, surgical events, and readmissions.
Morbid obesity was associated with the following elevated risks by adjusted odds ratio (aOR):
- Intensive care admission: 1.92 (95% confidence interval [CI] 1.61- 2.31, P<.001)
- Mortality: 1.54 (95% CI 1.16-2.05, P<.003)
- Colostomy: 1.34 (95% CI 1.25-1.43, P<.001)
- Open colectomy: 1.28 (95% CI: 1.21-1.34, P<.001)
- Open laparotomy: 1.84 (1.63-2.07, P<.001)
- Emergency surgery: 1.20 (95% CI 1.11-1.30, P<.001)
MO also was associated with higher risk for multiple hospital 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).
The authors note in the study’s conclusion that not only are more MO patients entering the hospital for diverticulitis, initial presentation is at a younger age as well.
They also underscore the need for strategies to ameliorate the country's obesity epidemic, a call made even more urgent by results of an analysis published in the New England Journal of Medicine in December 2019. Those findings predict that by 2030 approximately 1 in 2 adults will have obesity (48.9%) and nearly 1 in 4 adults is projected to have severe obesity. Nationally, the study authors write, severe obesity is poised to become the common BMI category among women (27.6%); non-Hispanic black adults (31.7%); and low-income adults (31.7%).