Assessing Socioeconomic Disparities in Outcomes: A Retrospective Analysis of Hartmann's Procedure vs PADLI Using the National Inpatient Sample.

BackgroundDiverticular disease affects over half of individuals over 60, with 25% developing diverticulitis. While Hartmann's procedure has traditionally been the standard for unstable patients, resection with primary anastomosis and diverting loop ileostomy (PADLI) is associated with higher stoma reversal rates and improved long-term outcomes. Despite evidence supporting PADLI, socioeconomic factors may influence procedural selection, contributing to persistent disparities in care.MethodsA retrospective cohort study was conducted using the 2015-2021 National Inpatient Sample (NIS) to identify patients undergoing emergent surgery for acute diverticulitis. Patients who received left colectomy or sigmoidectomy were classified by procedure type (Hartmann's vs PADLI) using ICD-10 codes. Demographic and socioeconomic factors were analyzed including age, sex, race, insurance type, income quartile, in-hospital mortality, length of stay, discharge disposition, and urban vs rural residency. The impact of these factors on procedure choice was assessed using multivariate logistic regression.ResultsAmong 14 551 patients, 85.5% underwent Hartmann's procedure and 14.5% received PADLI. Older age (OR 1.014/year, P < 0.001), female sex (OR 1.129, P = 0.011), white race (OR 1.128, P = 0.041), and lower income (OR 1.223, P < 0.001) were associated with higher odds of receiving Hartmann's procedure. Private insurance reduced this likelihood (OR 0.747, P < 0.001). Primary anastomosis and diverting loop ileostomy was more common in metropolitan areas, younger patients, those with private insurance, and those discharged routinely.DiscussionSocioeconomic disparities significantly influence surgical management of acute diverticulitis. Lower-income and publicly insured patients are more likely to undergo Hartmann's procedure, while PADLI is more common in wealthier, urban populations. Addressing these disparities could promote more equitable care and improve patient outcomes.