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Hospitalization for acute diverticulitis does not mandate routine elective colectomy.
Arch Surg. 2005 Jun; 140(6):576-81; discussion 581-3.AS

Abstract

BACKGROUND

Previous studies suggest that elective colectomy is often required after an episode of acute diverticulitis.

HYPOTHESIS

Acute diverticulitis initially treated nonoperatively does not require elective colectomy.

DESIGN

Retrospective cohort study.

SETTING

Twelve Kaiser Permanente hospitals in Southern California.

PATIENTS

Three thousand one hundred sixty-five patients with acute diverticulitis.

INTERVENTIONS

Colectomy or nonoperative treatment with or without percutaneous abscess drainage.

MAIN OUTCOME MEASURES

Recurrent diverticulitis.

RESULTS

Emergency colectomy was performed in 614 patients (19.4%). Nonoperative treatment was initially used in 2551 patients (80.6%). Of these, 185 patients (7.3%) had an elective colectomy and the remaining 2366 patients (92.7%) did not. Factors associated with undergoing elective colectomy compared with nonoperative treatment were younger age of the patient, fewer comorbidities, and percutaneous abscess drainage. Mean follow-up was 8.9 years, with a maximum of 12 years. After nonoperative treatment, 314 patients (13.3%) recurred-222 patients had a single recurrence and 92 patients had a rerecurrence. After adjusting for other variables, older age (hazard ratio, >/=50 years vs <50 years = 0.68; 95% confidence interval, 0.53-0.87) was associated with a lower recurrence, whereas higher comorbidity was associated with higher recurrence. Gender and percutaneous abscess drainage had no influence on recurrence. All 92 rerecurrences were treated nonoperatively. The risk of a rerecurrence (29.3%) was significantly higher than a first recurrence (P<.001). Age, gender, Charlson comorbidity index, and percutaneous abscess drainage did not predict rerecurrence.

CONCLUSIONS

Very few patients with acute diverticulitis treated nonoperatively have recurrence. Younger age was associated with recurrence. A first recurrence was the only factor that predicted rerecurrences. The low recurrence rate argues against routine elective colectomy after successful nonoperative management of acute diverticulitis.

Authors+Show Affiliations

Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15967905

Citation

Broderick-Villa, Gregory, et al. "Hospitalization for Acute Diverticulitis Does Not Mandate Routine Elective Colectomy." Archives of Surgery (Chicago, Ill. : 1960), vol. 140, no. 6, 2005, pp. 576-81; discussion 581-3.
Broderick-Villa G, Burchette RJ, Collins JC, et al. Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg. 2005;140(6):576-81; discussion 581-3.
Broderick-Villa, G., Burchette, R. J., Collins, J. C., Abbas, M. A., & Haigh, P. I. (2005). Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Archives of Surgery (Chicago, Ill. : 1960), 140(6), 576-81; discussion 581-3.
Broderick-Villa G, et al. Hospitalization for Acute Diverticulitis Does Not Mandate Routine Elective Colectomy. Arch Surg. 2005;140(6):576-81; discussion 581-3. PubMed PMID: 15967905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospitalization for acute diverticulitis does not mandate routine elective colectomy. AU - Broderick-Villa,Gregory, AU - Burchette,Raoul J, AU - Collins,J Craig, AU - Abbas,Maher A, AU - Haigh,Philip I, PY - 2005/6/22/pubmed PY - 2005/7/6/medline PY - 2005/6/22/entrez SP - 576-81; discussion 581-3 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 140 IS - 6 N2 - BACKGROUND: Previous studies suggest that elective colectomy is often required after an episode of acute diverticulitis. HYPOTHESIS: Acute diverticulitis initially treated nonoperatively does not require elective colectomy. DESIGN: Retrospective cohort study. SETTING: Twelve Kaiser Permanente hospitals in Southern California. PATIENTS: Three thousand one hundred sixty-five patients with acute diverticulitis. INTERVENTIONS: Colectomy or nonoperative treatment with or without percutaneous abscess drainage. MAIN OUTCOME MEASURES: Recurrent diverticulitis. RESULTS: Emergency colectomy was performed in 614 patients (19.4%). Nonoperative treatment was initially used in 2551 patients (80.6%). Of these, 185 patients (7.3%) had an elective colectomy and the remaining 2366 patients (92.7%) did not. Factors associated with undergoing elective colectomy compared with nonoperative treatment were younger age of the patient, fewer comorbidities, and percutaneous abscess drainage. Mean follow-up was 8.9 years, with a maximum of 12 years. After nonoperative treatment, 314 patients (13.3%) recurred-222 patients had a single recurrence and 92 patients had a rerecurrence. After adjusting for other variables, older age (hazard ratio, >/=50 years vs <50 years = 0.68; 95% confidence interval, 0.53-0.87) was associated with a lower recurrence, whereas higher comorbidity was associated with higher recurrence. Gender and percutaneous abscess drainage had no influence on recurrence. All 92 rerecurrences were treated nonoperatively. The risk of a rerecurrence (29.3%) was significantly higher than a first recurrence (P<.001). Age, gender, Charlson comorbidity index, and percutaneous abscess drainage did not predict rerecurrence. CONCLUSIONS: Very few patients with acute diverticulitis treated nonoperatively have recurrence. Younger age was associated with recurrence. A first recurrence was the only factor that predicted rerecurrences. The low recurrence rate argues against routine elective colectomy after successful nonoperative management of acute diverticulitis. SN - 0004-0010 UR - https://www.unboundmedicine.com/medline/citation/15967905/Hospitalization_for_acute_diverticulitis_does_not_mandate_routine_elective_colectomy_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.140.6.576 DB - PRIME DP - Unbound Medicine ER -