Predictors of urgent surgery in acute complicated diverticulitis: reassessing the indications for elective surgery: LTP17

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Aim:Traditionally, recurrent diverticulitis indicates an elective sigmoid resection toprevent a future urgent operation. Recent data have challenged this concept. We aimed to investigate risk factors for urgent operations (US), to better define indications for elective surgery (ES).Method:All patients who underwent surgery for sigmoid diverticulitis from 1997 to 2009 were retrospectively identified. Preoperative data of US and ES were compared using multivariate logistic regression analysis models.Results:One hundred and three US and 136 ES patients underwent surgery. 69% of US patients have not experienced aprevious episode of diverticulitis. US was significantly associated with older age (66.7 ± 14.7 vs 59.2 ± 12.5 years, OR: 1.05, 95% CI: 1.01-1.09), immunosuppression (3.73, 1.07-12.95) and lack ofprevious episodes (55.56, 17.86-166.67). Gender, co-morbidities, and smoking history were comparable. US had higher mortality (6% vs 0%, P = 0.006) and medical complications rates (34% vs 19%, P = 0.009). Surgical complications rates were similar. Stoma rates were significantly higher in US (79% vs 5%, P = 0.0001). Immunosuppression was significantly associated with increased morbidity and mortality in US group.Conclusion:Recurrent diverticulitis and young age are not risk factors for an urgent operation and therefore should not serve as a sole indication for elective surgery. Elective surgery is justified in patients under immunosuppression.

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