Impact of Dementia on Patients Admitted With Complicated Diverticular Disease: A U.S. Nationwide Analysis

TL;DR

This study finds that dementia is linked to higher mortality in patients with complicated diverticular disease, especially those with perforation or abscess.

Contribution

The novel contribution is identifying a significant mortality risk in dementia patients with specific CDD complications after adjusting for confounders.

Findings

Dementia patients with CDD had higher unadjusted in-hospital mortality.

Adjusted mortality was significantly higher in dementia patients with perforation or abscess.

Dementia was not significantly associated with mortality in diverticulitis or bleeding cases.

Abstract

Background

Emerging research has suggested a link between diverticular disease and dementia, potentially mediated by alterations in the gut microbiome and chronic systemic inflammation. This study aimed to evaluate in-hospital outcomes in patients admitted with complicated diverticular disease (CDD) and pre-existing dementia.

Methods

We used the 2021 National Inpatient Sample (NIS), which reflects 97% of the U.S. population. Patients admitted with CDD, defined as diverticulitis, abscess, perforation, or bleeding, were identified and stratified by the presence or absence of a prior dementia diagnosis. In-hospital mortality was compared between groups. Subgroup analysis evaluated the impact of specific complications (perforation/abscess vs. diverticulitis/bleeding) on mortality among patients with dementia. Multivariable logistic regression was used to adjust for potential confounders.

Results

Of 221,460 patients admitted with CDD, 9,160 (4.1%) had a comorbid dementia diagnosis. Patients with dementia were older (mean age 82.5 years), predominantly female (64.9%), and more likely to have multiple comorbidities. Overall, in-hospital mortality was higher in the dementia group (unadjusted OR 3.41; 95% CI: 2.38-4.90; p < 0.01), though this was not statistically significant after adjustment (aOR 1.45; 95% CI: 0.97-2.16; p = 0.07). Subgroup analysis revealed that dementia was significantly associated with increased mortality among patients with perforation or abscess (aOR 2.07; 95% CI: 1.07-4.04; p = 0.03), but not in those with diverticulitis or bleeding alone.

Conclusion

Pre-existing dementia was associated with higher unadjusted mortality, but it was not statistically significant after adjustment, except in patients with CDD who presented with perforation or abscess.