P4838 - Predictors of Complicated Diverticulitis in Obese Patients With and Without Prior Bariatric Surgery: A 5-Year National Inpatient Sample Analysis

Saksham Kohli, MBBS¹, Jhalak Agrohi, MBBS¹, Harendra Kumar, MBBS², Angad Tiwari, MBBS³, Ashish Sharma, MD⁴, Gedion Amdetsion, MD¹, Denise Nunez, DO¹, Maria Grba, DO¹, Daniel Guifarro Rivera, MD⁵, Abhin Sapkota, MBBS¹, Patricia Zarza Gulino, MD¹, Seema R. Gandhi, MD⁶
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 2Dow University of Health Sciences, Karachi, Sindh, Pakistan; 3Maharani Laxmi Bai Medical College, Ghaziabad, Uttar Pradesh, India; 4University of Connecticut-Hartford, Hartford, CT; 5Cook County Health and Hospital Systems, Chicago, IL; 6Cook County Health, Chicago, IL

Introduction: Obesity is a known risk factor for diverticular disease. While bariatric surgery (BS) confers metabolic benefits, its impact on the severity of diverticulitis, particularly complications such as abscess, perforation, and obstruction, remains unclear. This study aimed to identify predictors of complicated diverticulitis in obese patients and assess whether prior BS modifies this risk.

Methods: We performed a retrospective analysis of the National Inpatient Sample (2016–2020), identifying adults (≥18 years) with acute diverticulitis and obesity using ICD-10-CM codes. Severe cases were defined by presence of perforation, abscess, fistula, peritonitis, or obstruction. Multivariable logistic regression was used to assess predictors of complicated disease, adjusting for age, sex, race, smoking, comorbidities, insurance, income, and hospital factors. An interaction term evaluated whether BS modified the risk among patients with high comorbidity burden.

Results: Among 45,238 obese patients with diverticulitis, 9,946 (22.0%) had complicated disease. A total of 5,515 (12.2%) had prior BS. Complication rates were lower in the BS group (17.6%) than non-BS patients (22.7%, p< 0.001). Independent predictors of complications included older age (per 10 years: aOR 1.11, 95% CI: 1.08–1.15), male sex (aOR 1.23, 95% CI: 1.17–1.30), smoking (aOR 1.34, 95% CI: 1.25–1.43), malnutrition (aOR 1.45, 95% CI: 1.29–1.63), and CKD (aOR 1.29, 95% CI: 1.18–1.41). Prior BS was associated with a lower risk of complications (aOR 0.71, 95% CI: 0.62–0.80). A significant interaction was observed between BS and Charlson Comorbidity Index ≥3 (interaction p=0.02), suggesting greater benefit of BS in highly comorbid patients (aOR 0.58, 95% CI: 0.46–0.73). Model discrimination was strong (c-statistic = 0.78).

Discussion: In this national cohort, prior bariatric surgery was associated with a significantly lower risk of complicated diverticulitis in obese patients, especially among those with greater comorbidity burden. Traditional risk factors including age, male sex, smoking, malnutrition, and CKD remained significant predictors. These findings suggest that bariatric surgery may offer protective effects beyond metabolic health, informing future risk stratification and management of diverticulitis.


Figure: Predictors of Complicated Diverticulitis in Obese Patients

Disclosures:
Saksham Kohli indicated no relevant financial relationships.
Jhalak Agrohi indicated no relevant financial relationships.
Harendra Kumar indicated no relevant financial relationships.
Angad Tiwari indicated no relevant financial relationships.
Ashish Sharma indicated no relevant financial relationships.
Gedion Amdetsion indicated no relevant financial relationships.
Denise Nunez indicated no relevant financial relationships.
Maria Grba indicated no relevant financial relationships.
Daniel Guifarro Rivera indicated no relevant financial relationships.
Abhin Sapkota indicated no relevant financial relationships.
Patricia Zarza Gulino indicated no relevant financial relationships.
Seema Gandhi indicated no relevant financial relationships.

Saksham Kohli, MBBS¹, Jhalak Agrohi, MBBS¹, Harendra Kumar, MBBS², Angad Tiwari, MBBS³, Ashish Sharma, MD⁴, Gedion Amdetsion, MD¹, Denise Nunez, DO¹, Maria Grba, DO¹, Daniel Guifarro Rivera, MD⁵, Abhin Sapkota, MBBS¹, Patricia Zarza Gulino, MD¹, Seema R. Gandhi, MD⁶. P4838 - Predictors of Complicated Diverticulitis in Obese Patients With and Without Prior Bariatric Surgery: A 5-Year National Inpatient Sample Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.