Smoking Is Associated with an Increased Risk for Surgery in Diverticulitis: A Case Control Study

Michael J Diamant; Samuel Schaffer; Stephanie Coward; M Ellen Kuenzig; James Hubbard; Bertus Eksteen; Steven Heitman; Remo Panaccione; Subrata Ghosh; Gilaad G Kaplan

doi:10.1371/journal.pone.0153871

Smoking Is Associated with an Increased Risk for Surgery in Diverticulitis: A Case Control Study

PLoS One. 2016 Jul 28;11(7):e0153871. doi: 10.1371/journal.pone.0153871. eCollection 2016.

Authors

Michael J Diamant¹, Samuel Schaffer², Stephanie Coward^{1

3}, M Ellen Kuenzig^{1

3}, James Hubbard³, Bertus Eksteen¹, Steven Heitman^{1

3}, Remo Panaccione¹, Subrata Ghosh¹, Gilaad G Kaplan^{1

3}

Affiliations

¹ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
² Global Medical Affairs, Shire Canada Inc., Saint-Laurent, Quebec, Canada.
³ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

Abstract

Importance: Cigarette smoking increases the risk of surgery in Crohn's disease. However, the effect of smoking on the need for surgery for diverticulitis is unknown.

Objective: We evaluated whether smoking was a risk factor for surgery among patients admitted to hospital with acute diverticulitis.

Design: We conducted a population-based comparative cohort study of patients admitted to hospital for diverticulitis who were treated with medical versus surgical management.

Setting & participants: We used the population-based Discharge Abstract Database to identify 176 adults admitted emergently with a diagnosis of diverticulitis between 2009 and 2010 in Calgary.

Intervention & main outcome: We performed a medical chart review to confirm the diagnosis of diverticulitis and to extract clinical data. The primary outcome was a partial colectomy during hospitalization. Logistic regression evaluated the association between smoking and surgery after adjusting for potential confounders, including age, sex, comorbidity, and disease severity.

Results: A partial colectomy was performed on 35.6% of patients with diverticulitis and 1.3% died. Among diverticulitis patients, 26.8% were current smokers, 31.5% were ex-smokers, and 41.6% never smoked. Compared to non-smokers, current smokers (adjusted odds ratio [OR] 9.02; 95% confidence interval [CI]: 2.47-32.97) and former smokers (adjusted OR 5.41; 95% CI: 1.54-18.96) had increased odds of surgery.

Conclusion and relevance: Smoking is associated with the need for surgical management of diverticulitis.

Publication types

Comparative Study

MeSH terms

Aged
Case-Control Studies
Cohort Studies
Diverticulitis / surgery*
Female
Humans
Male
Middle Aged
Risk Factors
Smoking / adverse effects*

Grants and funding

Shire Development LLC provided funding for the study. The funder provided support in the form of salary for Dr. Samuel Schaffer, who is an employee of Shire. Dr. Schaffer and the funder were involved in the following aspects of the study: study concept and design, interpretation of the data, and critical revision of the manuscript for important intellectual content. The manuscript was written by Drs. Diamant and Kaplan. Under the direction of the authors, Jason Jung, PhD, an employee of MedErgy, provided editorial assistance for this manuscript. Representatives from Shire also reviewed this manuscript for scientific accuracy. Shire Development LLC provided funding to MedErgy for support in editing this manuscript. The final content of this manuscript and the decision to submit it for publication were agreed upon by all authors.