Emergency Surgery for Acute Left-Sided Complicated Diverticulitis in the Elderly: What Are the Predictor Factors of Mortality and Morbidity?

Introduction: Diverticular disease is common in Western countries, and the frequency of emergency operations for acute left-sided complicated diverticulitis (ALCD) has increased over the past 15 years. Methods: A total of 49 patients aged over 80 years and 125 younger patients who underwent emergency surgery for ALCD between October 2018 and June 2025 were analyzed. Demographics and postoperative outcomes were compared between the groups. Multivariate logistic regression was used to assess the association between age and postoperative morbidity and mortality. A separate regression model was used to identify risk factors for postoperative mortality and morbidity, specifically in elderly patients. Results: Significant differences between the two groups were found in sex distribution (p < 0.001), cardiovascular comorbidities (p < 0.001), chronic renal insufficiency (CRI) (p < 0.001), ASA score (p < 0.001), ALCD severity according to the modified Hinchey classification (p = 0.006), Mannheim Peritonitis Index (MPI) (p = 0.021), postoperative complications (p < 0.001), and 90-day mortality rates (p < 0.001). Advanced age was a significant predictor of 90-day postoperative mortality and morbidity. In the elderly subgroup, an ASA score ≥ 3, MPI > 25, CRI, and COPD were identified as independent predictors of 90-day postoperative mortality and morbidity. Conclusions: Advanced age is an independent risk factor for 90-day postoperative mortality and morbidity following emergency surgery for ALCD. In patients over 80 years, an ASA score ≥ 3, CRI, COPD, and MPI ≥ 25 are associated with a poorer prognosis.