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Prognostic factors of perforated sigmoid diverticulitis in the elderly.
Dig Surg. 2005; 22(1-2):100-6.DS

Abstract

BACKGROUND

The Finnish population is aging fast and the prevalence of perforated sigmoid diverticulitis is simultaneously increasing in northern Finland. The fact that an increasing number of elderly patients, with their age-specific problems, are subjected to emergency surgery for acute diverticulitis underlines the importance of risk stratification.

METHODS

One hundred and seventy-two patients admitted to Oulu University Hospital because of diverticular perforation from 1983 to 2002 were identified from the computer database. The clinical variables were evaluated as prognostic indicators of postoperative complications, mortality and time of hospitalization.

RESULTS

The resection rate was 91%; 64 primary anastomoses, 93 Hartmann's procedures and two covering colostomies were performed. The overall complication rate was 33%. In patients under 70 years, a stepwise logistic regression analysis showed that the Mannheim Peritonitis Index (MPI) score and American Society of Anesthesiologists (ASA) score were independent prognostic factors. None of factors predicted morbidity in patients over 70 years. Overall mortality rate was 8%, without any significant difference between the procedures. Of the clinical variables, MPI score, ASA score, Hinchey classes and malnutrition correlated with mortality. All patients who died presented with ASA scores of III-IV, and 12 out of 14 patients had an MPI score of II. In a stepwise logistic regression analysis, only the MPI score seemed to be an independent predictor of mortality.

CONCLUSIONS

Mortality is related to age but age alone is not an independent predictor of mortality. The MPI score is useful in predicting the risk of death in patients with perforated diverticulitis.

Authors+Show Affiliations

Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland. jyrki.makela@oulu.fiNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15849471

Citation

Mäkelä, Jyrki Tapani, et al. "Prognostic Factors of Perforated Sigmoid Diverticulitis in the Elderly." Digestive Surgery, vol. 22, no. 1-2, 2005, pp. 100-6.
Mäkelä JT, Kiviniemi H, Laitinen S. Prognostic factors of perforated sigmoid diverticulitis in the elderly. Dig Surg. 2005;22(1-2):100-6.
Mäkelä, J. T., Kiviniemi, H., & Laitinen, S. (2005). Prognostic factors of perforated sigmoid diverticulitis in the elderly. Digestive Surgery, 22(1-2), 100-6.
Mäkelä JT, Kiviniemi H, Laitinen S. Prognostic Factors of Perforated Sigmoid Diverticulitis in the Elderly. Dig Surg. 2005;22(1-2):100-6. PubMed PMID: 15849471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic factors of perforated sigmoid diverticulitis in the elderly. AU - Mäkelä,Jyrki Tapani, AU - Kiviniemi,Heikki, AU - Laitinen,Seppo, Y1 - 2005/04/20/ PY - 2004/09/03/received PY - 2005/01/12/accepted PY - 2005/4/26/pubmed PY - 2005/9/15/medline PY - 2005/4/26/entrez SP - 100 EP - 6 JF - Digestive surgery JO - Dig Surg VL - 22 IS - 1-2 N2 - BACKGROUND: The Finnish population is aging fast and the prevalence of perforated sigmoid diverticulitis is simultaneously increasing in northern Finland. The fact that an increasing number of elderly patients, with their age-specific problems, are subjected to emergency surgery for acute diverticulitis underlines the importance of risk stratification. METHODS: One hundred and seventy-two patients admitted to Oulu University Hospital because of diverticular perforation from 1983 to 2002 were identified from the computer database. The clinical variables were evaluated as prognostic indicators of postoperative complications, mortality and time of hospitalization. RESULTS: The resection rate was 91%; 64 primary anastomoses, 93 Hartmann's procedures and two covering colostomies were performed. The overall complication rate was 33%. In patients under 70 years, a stepwise logistic regression analysis showed that the Mannheim Peritonitis Index (MPI) score and American Society of Anesthesiologists (ASA) score were independent prognostic factors. None of factors predicted morbidity in patients over 70 years. Overall mortality rate was 8%, without any significant difference between the procedures. Of the clinical variables, MPI score, ASA score, Hinchey classes and malnutrition correlated with mortality. All patients who died presented with ASA scores of III-IV, and 12 out of 14 patients had an MPI score of II. In a stepwise logistic regression analysis, only the MPI score seemed to be an independent predictor of mortality. CONCLUSIONS: Mortality is related to age but age alone is not an independent predictor of mortality. The MPI score is useful in predicting the risk of death in patients with perforated diverticulitis. SN - 0253-4886 UR - https://www.unboundmedicine.com/medline/citation/15849471/Prognostic_factors_of_perforated_sigmoid_diverticulitis_in_the_elderly_ L2 - https://www.karger.com?DOI=10.1159/000085472 DB - PRIME DP - Unbound Medicine ER -