Does frailty predict readmission and mortality in diverticulitis? A nationwide analysis.

Abstract

Introduction: Diverticulitis is a major health concern in the United States affecting up to 25% of elderly population. It is unknown if frailty increases the risk of recurrent diverticulitis. The aim of our study is to identify the association between frailty and recurrence of diverticulitis.

Methods: We performed a retrospective analysis of the Nationwide Readmissions Database 2019 and included geriatric (65 years or older) patients admitted for acute complicated diverticulitis (ACD) who were managed nonoperatively between January and June and had a 6-month follow-up. Patients were stratified into nonfrail, prefrail, and frail groups using the five-factor modified frailty index. Primary outcome was readmission due to ACD or acute uncomplicated diverticulitis (AUD) at 1 and 6 months after the admission. Secondary outcome was mortality. Multivariable regression analysis was performed to identify the predictors of recurrent diverticulitis and outcomes.

Results: We identified 10,807 patients (nonfrail, 1,953; prefrail, 4,616; frail, 4,238). No differences were found between the groups in readmissions for recurrent ACD and AUD at 1 month after discharge. However, nonfrail patients and prefrail had higher rates of ACD (p = 0.009) and AUD (p < 0.001) at 6 months after index admission. Frail patients had higher mortality on index admission (p < 0.001) and at 6 months (p < 0.001). On multivariable regression analyses, frailty was a predictor of mortality on index (adjusted odds ratio, 1.99; p < 0.001) and readmissions (adjusted odds ratio, 3.05; p < 0.001).

Conclusion: Frailty was not identified as a predictor of developing recurrent diverticulitis; however, frail patients are at increased risk of mortality once they develop diverticulitis. Optimal management for frail patients with diverticulitis must be defined to improve outcomes.

Level of evidence: Therapeutic/Care Management; Level III.