Introduction: The prevalence of diverticulosis is as high as 50% in adults greater than 60 years old. Prior research on diverticular disease showed that these patients have an increased frequency of anxiety. Generalized anxiety disorder (GAD) is a common form of anxiety. This study explored the impact of GAD on the outcomes of patients admitted with acute diverticulitis.
Methods: Adults hospitalized for diverticulitis were selected from the 2014 National Inpatient Sample database. ICD-9 codes were used to select diagnoses. Demographic data and outcomes of diverticulitis were compared between a subgroup with GAD and a subgroup without GAD. The outcomes of interest were sepsis, acute renal failure (AKI), myocardial infarction (MI), acute respiratory failure, obstruction, colectomy, hypotension/shock, gastrointestinal perforation and inpatient mortality. Chi-squared tests and independent t-tests were used to compare proportions and means respectively. A multivariate logistic regression analysis was used to establish if GAD is an independent predictor for the outcomes after adjusting for age, sex, race, and Charlson Comorbidity Index (CCI).
Results: Among 77,520 diverticulitis patients in the study, 8,434 had GAD. Patients with GAD were younger (62.7 vs. 63.2 years old, p< 0.05), more likely to be female (72.6% vs. 43.5%, p< 0.05), more likely to be caucasian (83.9% vs. 75.5%, p< 0.05), and had a longer hospital stay (4.86 vs. 4.53 days, p< 0.05). There were no significant differences in total hospital charge ($40,003 vs. $39,660, p=0.54) and CCI (2.89 vs. 2.85, p=0.15). After adjusting for age, sex, race, and CCI, GAD was found to be a risk factor for obstruction (adjusted odds ratio (aOR) 1.22, 95% confidence interval (CI) 1.05-1.43, p< 0.05) and intestinal abscess (aOR 1.19, 95% CI 1.10-1.29, p< 0.05). GAD was also found to be a protective factor for acute respiratory failure (aOR 0.76, 95% CI 0.62-0.93, p< 0.05) and hypotension/shock (aOR 0.83, 95% CI 0.76-0.91, p< 0.05). The p-values for the aORs of sepsis (p=0.19), inpatient mortality (p=0.11), MI (p=0.77), AKI (p=0.76), and colectomy (p=0.07) were not statistically significant.
Discussion: In acute diverticulitis patients, GAD is a risk factor for intestinal obstruction and intestinal abscess, which may be due to GAD’s impact on motility. GAD is also a protective factor against acute respiratory failure and hypotension/shock possibly due to its association with higher healthcare utilization which may lead patients to seek out care earlier.
