eP583 - Smoking Is Not an Independent Risk Factor for More Severe Episodes of Acute Diverticulitis

Purpose/Background: Diverticulitis is a common disease process that affects a large number of patients annually with recent studies citing 1.92 million diagnoses in the ambulatory setting and more than 340,000 emergency department visits. There is a wide range of disease severity from uncomplicated episodes generally managed in an outpatient setting; to those that present with more severe and complicated disease (i.e., abscess, fistula, perforation) that often necessitates hospital admission. Given the significant variability in disease severity and the subsequent management, the goal of this study was to identify patient characteristics, co-morbid conditions, or signs/symptoms on initial presentation that are associated with perforation or abscess formation.Methods/Interventions: De-identified data from 2016-2019 of patients presenting with acute diverticulitis with and without perforation and/or abscess was obtained from the National Inpatient Sample after IRB approval. Statistical analysis software (SAS software version 9.4) was used to perform preliminary and matched analysis in attempt to identify an association between certain patient characteristics (demographics, presenting vital signs, laboratory results, comorbidities) and increased risk for perforation and/or abscess formation.Results/Outcomes: After adjusting for baseline patient characteristics, the study population included 50,020 patients in each well matched cohort. The presence of COPD, CAD, CKD, CHF, CAD, alcohol consumption, and immunocompromised status were all associated with a significant increased risk for perforation and/or abscess (p < 0.01). Diabetes mellitus (DM) was subclassified into uncomplicated and complicated disease. Patients with complicated DM showed a significant increased risk for perforation and/or abscess (p < 0.01) however, uncomplicated DM showed a significant association with uncomplicated diverticulitis (p < 0.01). Smoking status did not demonstrate an increased risk for perforation and/or abscess (p 0.22).Tachycardia (HR > 100 bpm), hypotension (SBP < 90 mmHg), fever (> 38 C), and hypoxia (SpO2 < 92%) on initial presentation were all associated with increased risk for perforation or abscess (p < 0.03).Conclusion/

Discussion: This retrospective review of a large patient population with acute diverticulitis demonstrates several significant risk factors for perforation and/or abscess formation. The data suggests that patients with co-morbid conditions, immunocompromised status, or with evidence of sepsis on presentation are at increased risk for more severe episodes of diverticulitis. This information may help to guide management in these patients who may require more aggressive treatment early in their disease course.In contrast to many other disease processes, smoking did not show an association with a more severe presentation of diverticulitis. This is an interesting finding that warrants further investigation.Table 1Association of patient risk factors and presenting vital signs with perforation and/or abscess in acute diverticulitis