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Do the risks of emergent colectomy justify nonoperative management strategies for recurrent diverticulitis?
Am J Surg 2009; 197(2):227-31AJ

Abstract

BACKGROUND

The nonoperative approach to recurrent and even multiple recurrent diverticulitis has recently been advocated. This approach, however, may result in more frequent acute attacks requiring emergent colectomy. Our aim was to compare the colectomy outcomes for diverticulitis in the elective and acute settings.

METHODS

All patients with diverticulitis undergoing elective (EL) and emergent (EM) colectomy selected from the 2001 to 2002 Nationwide Inpatient Sample Database were analyzed and compared.

RESULTS

Five thousand ninety-seven (27.1% emergent) colectomy cases were analyzed. EL patients had a significantly reduced length of stay (7.5 vs 13.3 days) and total hospital charges ($25,420 vs $51,170). Postsurgical morbidity and mortality were significantly higher in the EM group (29.0% vs 14.9% and 7.4% vs .8%, respectively). Colostomy was needed in 5.7% of EL and in 48.9% of EM patients (P = .001).

CONCLUSIONS

Emergent colectomy in the setting of diverticulitis is associated with significantly higher morbidity, longer hospitalization, greater hospital charges, and a 9-fold increase in mortality. Prophylactic resection in the setting of recurrent diverticulitis should continue to be an acceptable and possibly more "conservative" approach.

Authors+Show Affiliations

Department of Surgery, University of Connecticut Health Center, Farmington, CT, USA. novitsky@uchc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18639223

Citation

Novitsky, Yuri W., et al. "Do the Risks of Emergent Colectomy Justify Nonoperative Management Strategies for Recurrent Diverticulitis?" American Journal of Surgery, vol. 197, no. 2, 2009, pp. 227-31.
Novitsky YW, Sechrist C, Payton BL, et al. Do the risks of emergent colectomy justify nonoperative management strategies for recurrent diverticulitis? Am J Surg. 2009;197(2):227-31.
Novitsky, Y. W., Sechrist, C., Payton, B. L., Kercher, K. W., & Heniford, B. T. (2009). Do the risks of emergent colectomy justify nonoperative management strategies for recurrent diverticulitis? American Journal of Surgery, 197(2), pp. 227-31. doi:10.1016/j.amjsurg.2007.11.027.
Novitsky YW, et al. Do the Risks of Emergent Colectomy Justify Nonoperative Management Strategies for Recurrent Diverticulitis. Am J Surg. 2009;197(2):227-31. PubMed PMID: 18639223.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do the risks of emergent colectomy justify nonoperative management strategies for recurrent diverticulitis? AU - Novitsky,Yuri W, AU - Sechrist,Cathy, AU - Payton,B Lauren, AU - Kercher,Kent W, AU - Heniford,B Todd, Y1 - 2008/07/17/ PY - 2007/10/15/received PY - 2007/11/06/revised PY - 2007/11/06/accepted PY - 2008/7/22/pubmed PY - 2009/3/5/medline PY - 2008/7/22/entrez SP - 227 EP - 31 JF - American journal of surgery JO - Am. J. Surg. VL - 197 IS - 2 N2 - BACKGROUND: The nonoperative approach to recurrent and even multiple recurrent diverticulitis has recently been advocated. This approach, however, may result in more frequent acute attacks requiring emergent colectomy. Our aim was to compare the colectomy outcomes for diverticulitis in the elective and acute settings. METHODS: All patients with diverticulitis undergoing elective (EL) and emergent (EM) colectomy selected from the 2001 to 2002 Nationwide Inpatient Sample Database were analyzed and compared. RESULTS: Five thousand ninety-seven (27.1% emergent) colectomy cases were analyzed. EL patients had a significantly reduced length of stay (7.5 vs 13.3 days) and total hospital charges ($25,420 vs $51,170). Postsurgical morbidity and mortality were significantly higher in the EM group (29.0% vs 14.9% and 7.4% vs .8%, respectively). Colostomy was needed in 5.7% of EL and in 48.9% of EM patients (P = .001). CONCLUSIONS: Emergent colectomy in the setting of diverticulitis is associated with significantly higher morbidity, longer hospitalization, greater hospital charges, and a 9-fold increase in mortality. Prophylactic resection in the setting of recurrent diverticulitis should continue to be an acceptable and possibly more "conservative" approach. SN - 1879-1883 UR - https://www.unboundmedicine.com/medline/citation/18639223/Do_the_risks_of_emergent_colectomy_justify_nonoperative_management_strategies_for_recurrent_diverticulitis L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9610(08)00352-8 DB - PRIME DP - Unbound Medicine ER -