Population‐based study of outcomes following an initial acute diverticular abscess.
Published: 18th October 2018
Authors: C. T. Aquina, A. Z. Becerra, Z. Xu, C. F. Justiniano, K. Noyes, J. R. T. Monson et al.
Studies examining long‐term outcomes following resolution of an acute diverticular abscess have been limited to single‐institution chart reviews. This observational cohort study compared outcomes between elective colectomy and non‐operative management following admission for an initial acute diverticular abscess.
The Statewide Planning and Research Cooperative System was queried for unscheduled admissions for an initial acute diverticular abscess in 2002–2010. Bivariable and propensity‐matched multivariable analyses compared stoma rates and use of healthcare in patients who had an elective resection and those receiving non‐operative management. Diverticulitis recurrence rates were analysed for non‐operative management.
Among 10 342 patients with an initial acute diverticular abscess, one‐third (3270) underwent surgical intervention within 30 days despite initial non‐operative management. Of the remaining 7072 patients, 1660 had an elective colectomy within 6 months. Of 5412 patients receiving non‐operative management, 1340 (24·8 per cent) had recurrence of diverticulitis within 5 years (median 278 (i.q.r. 93·5–707) days to recurrence). Elective colectomy was associated with higher stoma rates (10·0 per cent, compared with 5·7 per cent for non‐operative observation, P < 0·001; odds ratio 1·88, 95 per cent c.i. 1·50 to 2·36), as well as more inpatient hospital days for diverticulitis‐related admissions (mean 8·0 versus 4·6 days respectively, P < 0·001; incidence rate ratio (IRR) 2·16, 95 per cent c.i. 1·89 to 2·47) and higher mean diverticulitis‐related cost (€70 107 versus €24 490, P < 0·001; IRR 3·11, 2·42 to 4·01).
Observation without elective colectomy following resolution of an initial diverticular abscess is a reasonable option with lower healthcare costs than operation.Full text
You may also be interested in
Authors: L. Koskenvuo, N. Malila, J. Pitkäniemi, J. Miettinen, S. Heikkinen, V. Sallinen et al.
Notes: Only of benefit in men.
Authors: I. van 't Sant, W. J. van Eden, M. P. Engbersen, N. F. M. Kok, K. Woensdregt, D. M. J. Lambregts et al.
Notes: Promising staging tool
Cost‐effectiveness of liver transplantation in patients with colorectal metastases confined to the liver.
Authors: G. M. W. Bjørnelv, S. Dueland, P.‐D. Line, P. Joranger, Å. A. Fretland, B. Edwin et al.
Notes: Not for every country
Systematic review of treatment intensification using novel agents for chemoradiotherapy in rectal cancer. BJS 2018; 105: 1553-1572.
Authors: R. Clifford, N. Govindarajah, J. L. Parsons, S. Gollins, N. P. West, D. Vimalachandran et al.
Notes: Promising agents coming
Authors: R. Ahl, P. Matthiessen, X. Fang, Y. Cao, G. Sjolin, R. Lindgren et al.
Notes: Reduces mortality
Authors: H. Elfeki, H. M. Larsen, K. J. Emmertsen, P. Christensen, M. Youssef, W. Khafagy et al.
Notes: Sigmoid resection associated with bowel dysfunction
Authors: J. Segelman, C. Buchli, A. Svanström Röjvall, P. Matthiessen, S. Arver, M. Bottai et al.
Notes: Ovarian androgens reduced
Randomized clinical trial
Randomized clinical trial of short or long interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. BJS 2018; 105: 1417-1425.
Authors: E. Akgun, C. Caliskan, O. Bozbiyik, T. Yoldas, M. Sezak, S. Ozkok et al.
Notes: Worth waiting
CCR‐CARESS score for predicting operative mortality in patients with colorectal cancer. BJS 2018; 105: 1853-1861.
Authors: M. Baré, L. Mora, N. Torà, M. J. Gil, I. Barrio, P. Collera et al.
Notes: Elderly co‐morbid patients at high risk
Preoperative oral care and effect on postoperative complications after major cancer surgery. BJS 2018; 105: 1688-1696.
Authors: M. Ishimaru, H. Matsui, S. Ono, Y. Hagiwara, K. Morita, H. Yasunaga et al.
Notes: Preoperative dental care reduces postoperative pneumonia
Prognostic implications of MRI‐detected lateral nodal disease and extramural vascular invasion in rectal cancer. BJS 2018; 105: 1844-1852.
Authors: D. P. Schaap, A. Ogura, J. Nederend, M. Maas, J. S. Cnossen, G. J. Creemers et al.
Notes: Defines recurrence risk
Multicentre international trial of laparoscopic lavage for Hinchey III acute diverticulitis (LLO Study). BJS 2018; 105: 1835-1843.
Authors: G. A. Binda, M. A. Bonino, G. Siri, S. Di Saverio, G. Rossi, R. Nascimbeni et al.
Notes: Successful in the majority