Should diverticulitis be considered a qualifying weight related comorbidity for bariatric surgery?

Abstract

Abstract Introduction: With rising obesity rates, surgeons are operating on increasingly larger patients. Minimally invasive surgery has helped ease this burden on surgeons. However, we are still quantifying the impact of weight on surgical outcomes. The purpose of this study is to determine the role of obesity in elective laparoscopic colectomy for colonic diverticulitis. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and colectomy targeted procedure databases were queried from 2012-2019, examining patients undergoing elective, minimally invasive partial colectomy with or without primary anastomosis for an indication of diverticulitis. Patients with a BMI under 30 (non-obese) were compared to patients with a BMI between 35-40 (obese). The groups were propensity score matched for pre-operative and intra-operative variables. Results: 2,217 patients were identified with 1,954 non-obese patients and 263 obese patients. The groups’ average BMIs were 25.3 ± 3 and 37.1 ± 1.5, respectively. There were no significant differences between the two groups after a 2:1 propensity score match. In obese patients, there were higher rates of conversion to open (11.49% vs 7.09%, p =0.038), operative time (178.5 vs 167.0 minutes, p = 0.044), and readmission (7.28% vs 3.64%, p = 0.025). The leak rate was 4.98% for obese patients vs. 2.68% for non-obese patients, though this was not statistically significant (p=0.097). Conclusion: Obese patients undergoing elective laparoscopic colectomies for diverticulitis suffer from increased rates of conversion to open, operative time, and readmission. Diverticulitis should be strongly considered for inclusion as a qualifying weight related comorbidity for bariatric surgery as significant weight loss prior to diverticulitis surgery improves outcomes.