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Risk of emergency colectomy and colostomy in patients with diverticular disease.
Arch Surg 2005; 140(7):681-5AS

Abstract

HYPOTHESIS

Patients with diverticulitis are at a lifetime risk for emergency colectomy and colostomy. Age and recurrence characteristics can serve to predict the risk for these adverse outcomes.

DESIGN

Time-to-event analysis and logistic regression were used to determine the risk of emergency colectomy/colostomy.

SETTING AND PATIENTS

A retrospective cohort study using a statewide administrative database and identifying all patients hospitalized nonelectively for diverticulitis (1987-2001).

MAIN OUTCOME MEASURE

Emergency colectomy and/or colostomy in patients treated nonsurgically after a first episode of acute diverticulitis.

RESULTS

A total of 25 058 patients (mean age [ +/- SD], 69 [16] years, 60% female) were hospitalized for an initial episode of diverticulitis. Of the 20 136 patients treated without initial operation, 19% had recurrences, with younger patients (<50 years) more likely to have a recurrence than older patients (27% vs 17%, P<.001). While only 5.5% of patients had recurrent hospitalizations during which an emergency colectomy/colostomy was performed, it occurred more commonly in younger patients (7.5% vs 5%, P<.001). The adjusted hazard ratio for emergency colectomy/colostomy in younger patients was 39% higher than in older patients (hazard ratio, 1.39; 95% confidence interval, 1.21-1.62). Among all patients, the adjusted hazard ratio for emergency colectomy/colostomy was 2.2 times higher with each subsequent admission (hazard ratio, 2.2; 95% confidence interval, 2.1-2.2). The predicted probability of emergency colectomy/colostomy was highest in younger patients with multiple rehospitalizations.

CONCLUSIONS

Age and number of recurrent events were associated with the risk of emergency colectomy/colostomy after successful nonoperative management in patients with diverticulitis. Individualization of recommendations regarding elective colectomy based on these factors may be more appropriate than the application of previously published strategies.

Authors+Show Affiliations

Department of Surgery, University of Washington, Seattle 98195, USA.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16027334

Citation

Anaya, Daniel A., and David R. Flum. "Risk of Emergency Colectomy and Colostomy in Patients With Diverticular Disease." Archives of Surgery (Chicago, Ill. : 1960), vol. 140, no. 7, 2005, pp. 681-5.
Anaya DA, Flum DR. Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg. 2005;140(7):681-5.
Anaya, D. A., & Flum, D. R. (2005). Risk of emergency colectomy and colostomy in patients with diverticular disease. Archives of Surgery (Chicago, Ill. : 1960), 140(7), pp. 681-5.
Anaya DA, Flum DR. Risk of Emergency Colectomy and Colostomy in Patients With Diverticular Disease. Arch Surg. 2005;140(7):681-5. PubMed PMID: 16027334.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of emergency colectomy and colostomy in patients with diverticular disease. AU - Anaya,Daniel A, AU - Flum,David R, PY - 2005/7/20/pubmed PY - 2005/8/12/medline PY - 2005/7/20/entrez SP - 681 EP - 5 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 140 IS - 7 N2 - HYPOTHESIS: Patients with diverticulitis are at a lifetime risk for emergency colectomy and colostomy. Age and recurrence characteristics can serve to predict the risk for these adverse outcomes. DESIGN: Time-to-event analysis and logistic regression were used to determine the risk of emergency colectomy/colostomy. SETTING AND PATIENTS: A retrospective cohort study using a statewide administrative database and identifying all patients hospitalized nonelectively for diverticulitis (1987-2001). MAIN OUTCOME MEASURE: Emergency colectomy and/or colostomy in patients treated nonsurgically after a first episode of acute diverticulitis. RESULTS: A total of 25 058 patients (mean age [ +/- SD], 69 [16] years, 60% female) were hospitalized for an initial episode of diverticulitis. Of the 20 136 patients treated without initial operation, 19% had recurrences, with younger patients (<50 years) more likely to have a recurrence than older patients (27% vs 17%, P<.001). While only 5.5% of patients had recurrent hospitalizations during which an emergency colectomy/colostomy was performed, it occurred more commonly in younger patients (7.5% vs 5%, P<.001). The adjusted hazard ratio for emergency colectomy/colostomy in younger patients was 39% higher than in older patients (hazard ratio, 1.39; 95% confidence interval, 1.21-1.62). Among all patients, the adjusted hazard ratio for emergency colectomy/colostomy was 2.2 times higher with each subsequent admission (hazard ratio, 2.2; 95% confidence interval, 2.1-2.2). The predicted probability of emergency colectomy/colostomy was highest in younger patients with multiple rehospitalizations. CONCLUSIONS: Age and number of recurrent events were associated with the risk of emergency colectomy/colostomy after successful nonoperative management in patients with diverticulitis. Individualization of recommendations regarding elective colectomy based on these factors may be more appropriate than the application of previously published strategies. SN - 0004-0010 UR - https://www.unboundmedicine.com/medline/citation/16027334/Risk_of_emergency_colectomy_and_colostomy_in_patients_with_diverticular_disease_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.140.7.681 DB - PRIME DP - Unbound Medicine ER -