LB801 - A COSMID Score? Evidence-Based Diverticulitis Care Through Predictive Scores - Baseline Analysis from an Ongoing Randomized Trial

Monday, June 3, 2024

3:48 PM – 3:54 PM ET, USA

Location: Room 314-317

Abstract Podium Presenter(s)

Mariam N. Hantouli, MD (she/her/hers)

Acting Instructor
Department of Surgery University of Washington
Seattle, WA, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

DF

David R. Flum, MD, MPH

Professor of Surgery, and Adjunct Professor School of Public Health and Pharmacy, Vice Chair
Department of Surgery University of Washington
Seattle, Washington, United States

Disclosure information not submitted.

Author(s)

RS

Robert. Schmicker, MS

Biostatistician
University of Washington Center for Biomedical Statistics
Seattle, Washington, United States

Disclosure information not submitted.
BC

Bryan A. Comstock, MS

Senior Biostatistician
Department of Biostatistics, University of Washington
Seattle, Washington, United States

Disclosure information not submitted.
GD

Giana H. Davidson, MD, MPH, FACS

Professor of Surgery, Adjunct Professor, Department of Health Systems and Population Health
Department of Surgery University of Washington
Seattle, Washington, United States

Disclosure information not submitted.
Thomas E. Read, MD

Professor and Chief, Division of Gastrointestinal Surgery
University of Florida
University of Florida College of Medicine
Gainesville, FL, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
KP

Kelsey M. Pullar, MPH

Research Manager
Department of Surgery, University of Washington
Seattle, Washington, United States

Disclosure information not submitted.
JM

James McCormick, DO, FACS, FASCRS

Professor of Surgery, Drexel University; Chief, Colorectal Surgery, AHN; Chair, CRC program, AHNCI
Allegheny Health Network
pittsburgh, Pennsylvania, United States

Disclosure information not submitted.
Vlad V. Simianu, MD, MPH

Medical Director, Colon and Rectal Disorders
Virginia Mason Franciscan Health
Seattle, Washington, United States

Disclosure information not submitted.
SM

Stefanos G. Millas, MD, FACS

Associate Professor of Surgery
UT Health McGovern Medical School, LBJ General Hospital
Houston, Texas, United States

Disclosure information not submitted.
Irena Gribovskaja-Rupp, MD (she/her/hers)

Clinical Associate Professor
University of Iowa Hospitals and Clinics
University of Iowa Hospitals & Clinics
Iowa City, Iowa, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Jessica N. Cohan, MD, MAS, FACS, FASCRS (she/her/hers)

Assistant Professor of Surgery, Adjunct Assistant Professor of Population Health Sciences
University of Utah
University of Utah
Salt Lake City, Utah, United States

Disclosure information not submitted.
CR

Caroline E. Reinke, MD

Clinical Associate Professor
Atrium Health
Charlotte, North Carolina, United States

Disclosure information not submitted.
FF

Fergal Fleming, MD MPH FRCSI FACS

Associate Professor of Surgery and Oncology
University of Rochester Medical Center
University of Rochester Medical Center
Rochester, NY, United States

Disclosure information not submitted.
HG

Henry R. Govekar, MD, FACS, FASCRS

Assistant Professor, Division of Colon & Rectal Surgery, Department of Surgery
RUSH Medical College
Chicago, Illinois, United States

Disclosure information not submitted.
KF

Katherine N. Fischkoff, MD

Associate Professor of Surgery
Columbia University
New York, New York, United States

Disclosure information not submitted.
Jennifer Davids, Associate Professor of Surgery (she/her/hers)

Chief of Colon and Rectal Surgery
Boston Medical Center
Boston University
Boston, Massachusetts, United States

Disclosure information not submitted.
NW

Nicole Wieghard, MD, FACS, FASCRS

Assistant Professor
Virginia Commonwealth University
richmond, Virginia, United States

Disclosure information not submitted.
Arden Morris, MD, MPH, FACS

Professor of Surgery
Stanford University
Stanford University School of Medicine
Palo Alto, California, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Thomas Curran, MD, MPH

Associate Professor
Medical University of South Carolina
Medical University of South Carolina
Charleston, South Carolina, United States

Disclosure information not submitted.
RB

Robert D. Bennett, MD

Assistant Professor of Surgery,
University of South Florida
Tampa, Florida, United States

Disclosure information not submitted.
JS

Julia T. Saraidaridis, MD, MMSc

Staff Colon and Rectal Surgeon
Lahey Hospital
Newton, Massachusetts, United States

Disclosure information not submitted.
AP

Anantha Padmanabhan, MD, FACS, FASCRS

Clinical Assistant Professor of Surgery, The Ohio State University, Program Director
Mount Carmel Health System
Columbus, Ohio, United States

Disclosure information not submitted.
Karen Zaghiyan, MD

Assistant Professor of Surgery
Cedars-Sinai
Cedars Sinai Medical Center
Los Angeles, California, United States

Disclosure information not submitted.
Elizabeth Wick, MD

Professor
UCSF
University of California, San Francisco
San Francisco, California, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Samuel Eisenstein, MD (he/him/his)

Associate Professor
UC San Diego Health
UC San Diego Health
La Jolla, CA, United States

Disclosure information not submitted.

Image or Table (Do Not add text here):

Purpose/Background: Annually, 2-4 million individuals experience diverticulitis episodes in the United States alone. The American Society of Colon and Rectal Surgeons recommends individualizing surgical decisions based on diverticulitis impact on patients’ quality of life (QoL), yet no established threshold or predictive scores exist to guide when surgery is more beneficial. Evidence comparing the effectiveness of elective colectomy compared with medical management for uncomplicated diverticulitis is scarce. To address these gaps, the ongoing Comparing Outcomes of Surgery and Medicine on the Impact of Diverticulitis (COSMID) trial, a patient-level randomized study, aims to compare these treatment options and to identify factors influencing differential patient outcomes, a key component of predictive scoring and decision-aid tools. Multiple QoL instruments are used in COSMID to measure patients’ QoL. While COSMID continues to recruit, we assessed the correlation between these QoL instruments to inform future predictive scoring and to accurately assess outcomes based on QoL impact.

Methods/Interventions: Patients with QoL-limiting uncomplicated diverticulitis from 29 centers (2019 – 2023) were enrolled and surveyed at the time of enrollment (baseline). We assessed participants’ (1) general QoL using the Patient-reported Outcomes Measurement Information System instrument (PROMIS) global health, which assesses generic physical health and mental health; (2) system-specific QoL using the Gastrointestinal Quality of Life Index (GIQLI, 0 to 144 scale, higher scores representing better QoL); and (3) disease-specific QoL using the Diverticulitis QoL instrument (DVQOL, 0 to 10 scale, lower scores indicating better QoL). We examined the correlation between the instruments using Spearman ρ analysis. Although participants are followed longitudinally in COSMID, this analysis was restricted to baseline data because COSMID is an ongoing trial.

Results/Outcomes: Of 266 participants enrolled, 233 (88%) completed all four instruments of interest (mean age 56.0, SD 12.5; 58.7% female). At baseline, median PROMIS Physical and Mental Health were 47.7, 48.3 (IQR 39.8-50.8, 43.5-53.3, respectively). Median GIQLI was 97.5 (IQR 82.0-113.8), and median DVQOL was 3.7 (IQR 2.3-5.2). GIQLI was highly correlated with DVQOL (ρ=-0.83, 95%CI: -0.77, -0.87), PROMIS Physical Health (ρ=0.62, 95% CI: 0.53, 0.70), and moderately correlated with PROMIS Mental Health (ρ=0.49, 95%CI: 0.38, 0.58). DVQOL was moderately correlated with PROMIS Physical (ρ=-0.51, 95% CI: -0.41, -0.61), and Mental Health (ρ=-0.44, 95% CI: -0.33, -0.55) (Figure).

Conclusion/Discussion: Individualizing diverticulitis-related treatment decisions is critical for more patient-centered care but requires the identification of differential treatment effects based on patients’ characteristics. We found varying correlations among baseline diverticulitis-related QoL measures, suggesting that components of these measures may be candidate characteristics for a predictive score. In developing a practical COSMID predictive score, parsimonious factor reduction will be applied and tested among trial participants.