The Impact of Social Determinants of Health on Ostomy Reversal in Diverticulitis

Abstract

Background: Colectomy with temporary ostomy remains the most prevalent surgical management of diverticulitis. Many of these temporary ostomies, unfortunately, are never reversed. The purpose of this study was to evaluate the impact of social determinants of health on rate and timing of ostomy reversal.

Methods: We performed a retrospective cohort study of patients who underwent ostomy creation for diverticulitis from January 2018 to December 2022 and were followed until December 2023. The primary aim was to determine the effect of social determinants of health on time to and rate of ostomy reversal.

Results: 109 patients underwent ostomy creation, either Hartmann's procedure (HP) or primary anastomosis with diverting loop ileostomy (PA+). Most procedures were urgent (73%) and 55% of patients underwent HP. 98 patients (89.9%) underwent ostomy reversal. Patients who did not undergo ostomy reversal were more likely to be older (p=0.029), non-white (p=0.004), live in at risk neighborhoods (p=0.004), unhoused (p<0.001), widowed (p<0.001), and have HP (p=0.007). Patients who had delayed reversal (> 6 months) were more likely to be female (p=0.02), have HP (p = 0.003), experience complication (p=0.004), have longer length of stay (p=0.04), and be discharged to skilled nursing facility (p=0.03). Female sex (p=0.003), living in at risk neighborhoods (p=0.026), complication (p=0.005), and HP (p=0.007) were found to be independent predictors of delayed reversal.

Conclusion: Social determinants of health should be taken into consideration during intra-operative decision making for diverticulitis.