Morbid Obesity Linked to Worse Diverticulitis Outcomes

Grace Halsey

Morbid obesity significantly increases risks associated with diverticulitis including open surgeries and mortality, according to new research.

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%).