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Background: Recent genetic studies identified common mutations between diverticular disease and connective tissue disorders, some of which are associated with abdominal wall hernias. Scarce data exists, however, shedding light on the potential clinical implications of this shared etiology, particularly in the era of laparoscopic surgery., Methods: The New York Statewide Planning and Research Cooperative System database was used to identify adult patients undergoing elective sigmoid and left hemicolectomy (open or laparoscopic) from January 1, 2010, to December 31, 2016, for diverticulitis or descending/sigmoid colon cancer. The incidences of incisional hernia diagnosis and repair were compared using competing risks regression models, clustered by surgeon and adjusted for a host of demographic/clinical variables. Subsequent abdominal surgery and death were considered competing risks., Results: Among 8279 patients included in the study cohort, 6811 (82.2%) underwent colectomy for diverticulitis and 1468 (17.8%) for colon cancer. The overall 5-year risk of incisional hernia was 3.5% among patients with colon cancer, regardless of colectomy route, which was significantly lower than that among diverticulitis patients after both open (10.7%; p < 0.001) and laparoscopic (7.2%; p = 0.007) colectomies. Multivariable analyses demonstrated that patients with diverticulitis experienced a two-fold increase in the risk for hernia diagnosis (aHR 1.8; p < 0.001) and repair (aHR 2.1; p < 0.001), and these findings persisted after stratification by colectomy route., Conclusions: Patients undergoing elective colectomy for diverticulitis, including via laparoscopic approach, experience higher rates of incisional hernia compared with patients undergoing similar resections for colon cancer. When performing resections for diverticulitis, surgeons should strongly consider adherence to evidence-based guidelines for fascial closure to prevent this important complication.

Background: Current guidelines accept partial colectomy and primary anastomosis with proximal diversion for select patients with perforated diverticulitis based on low-quality evidence., Objective: This study aimed to compare the effect of operative approach and surgeon training on outcomes following urgent/emergent colectomy for diverticulitis., Design: This is a statewide retrospective cohort study., Setting: Data were obtained from the New York State all-payer sample from 2000 to 2014., Patients: All patients who underwent an urgent/emergent sigmoid colectomy for diverticulitis with creation of an end colostomy or primary anastomosis with proximal diversion were included. We excluded all patients age <18 years, with IBD, colorectal cancer, ischemic colitis, or elective operations., Main Outcome Measures: The main outcomes measured were postoperative in-hospital mortality and complications, RESULTS:: A total of 10,780 patients underwent urgent/emergent colectomy for diverticulitis: 10,600 (98.3%) received a Hartmann procedure and 180 (1.7%) received primary anastomosis with proximal diversion. Colorectal surgeons performed 6.0% of all operations. Utilization of primary anastomosis with proximal diversion was greater among colorectal surgeons but remained low overall (4.2% vs 1.5%; p < 0.001). Postoperative mortality was 2-fold greater when noncolorectal surgeons performed primary anastomosis vs Hartmann procedure (15% vs 7.4%; p < 0.001) and 1.4 times greater among noncolorectal surgeons than among colorectal surgeons (7.5% vs 5.3%; p = 0.04). On multivariable logistic regression (adjusting for patient demographics/characteristics, year, hospital academic status, and surgeon training) primary anastomosis with proximal diversion remained associated with increased mortality (OR, 2.7; 95% CI,1.7-4.4; p < 0.001), complications (OR, 1.8; 95% CI, 1.3-2.5; p < 0.001), and reoperation (OR, 3.4; 95% CI, 1.8-6.3; p < 0.001), whereas colorectal board certification was associated with decreased mortality (OR, 0.66; 95% CI, 0.46-0.95; p = 0.03)., Limitations: Selection bias secondary to retrospective nature and absence of disease severity were limitations of this study., Conclusions: Despite current recommendations for primary anastomosis with proximal diversion for perforated diverticulitis, this operation in New York State was associated with increased postoperative morbidity and mortality when performed by general surgeons. Given that the majority of urgent/emergent colectomies for diverticulitis are not performed by colorectal surgeons, guidelines for operative management of perforated diverticulitis should be reevaluated. See Video Abstract at http://links.lww.com/DCR/A772.

Background: As of October 1, 2008, the Centers for Medicare and Medicaid Services stopped payment for 8 "preventable" conditions: retained foreign body, air embolism, blood incompatibility, catheter-associated urinary tract infection, pressure ulcer, vascular catheter-associated infection, mediastinitis, and hospital fall. Our hypothesis was that surgeons are frequently involved in the care of patients deemed to have "preventable" conditions., Study Design: This is a retrospective cohort of patients with "preventable" conditions identified from 2004 California and New York discharge data. The proportion of patients who required a surgical procedure during the index hospital stay was then determined., Results: "Preventable" conditions were identified in 286,509 (4%) of 6,618,637 total patient discharges, of which 224,073 (78.2%) were insured by Medicare or Medicaid. A surgical procedure was performed in 168,886 (59.5%) patients. In the subset that developed a "preventable" condition during the index hospital stay, 1 or more surgical procedures were performed in 100% of patients with mediastinitis; 96% of patients with retained foreign bodies; 96% of patients with air embolism; 92% of patients with vascular catheter-associated infections; 79% of patients with blood incompatibility; 70% of patients with catheter-associated urinary tract infections; and 65% of patients with pressure ulcers. The most common surgical procedures were cardiovascular, gastrointestinal, and respiratory., Conclusions: A large number of patients are coded as having "preventable" conditions, and surgeons are frequently involved in their care. Nonpayment for "preventable" conditions may lead hospitals and surgeons to avoid complex procedures, refuse care to high-risk patients, or both.