eP699 - Lessons Learned from COVID Surgery Cancellations in Diverticular Disease

Purpose/Background: COVID-19 caused many significant changes in healthcare utilization. Amongst these changes was the substantial number of elective surgery cancellations, a subset of which were patients with diverticulitis who were scheduled to undergo elective colectomy. The necessary delays in surgical intervention for diverticulitis patients provide an opportunity to better understand the natural history of diverticulitis patients who were selected for surgical intervention. This study aimed to identify and follow those patients whose elective colectomy was postponed in order to evaluate for risk of recurrence.Methods/Interventions: A retrospective cohort study was performed using all patients aged 18 and over who were scheduled to undergo elective surgery for diverticulitis during peak COVID-19 surge as well as continued cancellations due to short staffing and patients testing positive for COVID, March 2020 through present day. Patients were identified using both ICD diagnosis code and CPT code. Charts were reviewed for clinicodemographic information from the time of first admission for diverticulitis to the time of their originally scheduled surgery. This information included age, sex, BMI, smoking status, CT findings (abscess formation, size, and location of abscess), need for IR percutaneous drainage (PD), and choice of antibiotic (IV vs PO) at discharge. The primary outcome was whether patients with cancelled elective surgery were readmitted to the hospital for diverticulitis treatment before their rescheduled surgery. Secondary outcomes included need for emergent (within 24 hours of admission) or urgent (>24 hours from admission) operation prior to their rescheduled elective surgery, length of stay during readmission, and need for PD.Results/Outcomes: Twenty-seven patients were identified, 13 (48.1%) with complicated diverticulitis with abscess formation (four patients (14.8%) underwent PD for abscess (3 with pericolic and 1 with pelvic abscess) and 14 (51.9%) with uncomplicated disease. There were 12 (44.4%) males, mean age was 58.3 years (SD 12.6), 4 (14.8%) were current smokers (13 or 38.2% former smokers), and 89.9% (24) of patients had BMI of 25 or greater. Median time to colectomy from the cancelled date of surgery in all patients was 74 days (IQR 47-154), with a maximum of 3.4 years. Of all patients, only 1 patient was readmitted prior to their rescheduled surgery and underwent emergent Hartmann’s procedure 6 days prior to their original surgery date. This patient had complicated diverticulitis at presentation with a large, 14 cm pelvic abscess requiring PD.Conclusion/

Discussion: With a median rescheduling time of 2 months, there was only one recurrence, which resulted in an emergent Hartmann’s procedure. This patient was likely already at high risk for recurrence given severity of initial disease. Despite advances in our understanding of the natural history of diverticulitis, it is still difficult to predict the timing of recurrences, and the timeframe within which to proceed with elective surgery unclear. At least in this small cohort, it seems that for patients with recurrent uncomplicated disease or complicated disease with smaller abscess formation can be scheduled at a convenient time for patients and surgeons. This natural experiment from COVID cancellations/postponements may be used to guide elective surgery scheduling for providers as they consider timing and risk factors from diverticulitis.