Complicated diverticulitis

Is it time to rethink the rules?

Jennifer Chapman, Michael Davies, Bruce Wolff, Eric Dozois, Deron Tessier, Jeffrey Harrington, Dirk Larson, Robert D. Fry, Merril T. Dayton

Research output: Contribution to journalArticle

229 Citations (Scopus)

Abstract

Introduction: Much of our knowledge and treatment of complicated diverticulitis (CD) are based on outdated literature reporting mortality rates of 10%. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce morbidity and mortality. The aim of this study is to update our understanding of the morbidity, mortality, characteristics, and outcomes of CD. Methods: Three hundred thirty-seven patients hospitalized for CD were retrospectively analyzed. Characteristics and outcomes were determined using chi-squared and Fisher exact tests. Results: Mean age of patients was 65 years. Seventy percent had one or more comorbidities. A total of 46.6% had a history of at least one prior diverticulitis episode, whereas 53.4% presented with CD as their first episode. Overall mortality rate was 6.5% (86.4% associated with perforation, 9.5% anastomotic leak, 4.5% patient managed nonoperatively). A total of 89.5% of the perforation patients who died had no history of diverticulitis. Steroid use was significantly associated with perforation rates as well as mortality (P < 0.001 and P = 0.002). Comorbidities such as diabetes, collagen-vascular disease, and immune system compromise were also highly associated with death (P = 0.006, P = 0.009, and P = 0.003, respectively). Overall morbidity was 41.4%. Older age, gender, steroids, comorbidities, and perforation were significantly associated with morbidity. Conclusion: Today, mortality from CD excluding perforation is reduced compared with past data. This, coupled with the fact that the majority of these patients presented with CD as their first episode, calls into question the current practice of elective resection as a stratagem for reducing mortality. Immunocompromised patients may benefit from early resection. New prospective data is needed to redefine target groups for prophylactic resection.

Original languageEnglish (US)
Pages (from-to)576-583
Number of pages8
JournalAnnals of Surgery
Volume242
Issue number4
DOIs
StatePublished - Oct 1 2005

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Diverticulitis
Mortality
Morbidity
Comorbidity
Steroids
Collagen Diseases
Anastomotic Leak
Immune System Diseases
Immunocompromised Host
Vascular Diseases

ASJC Scopus subject areas

  • Surgery

Cite this

Chapman, J., Davies, M., Wolff, B., Dozois, E., Tessier, D., Harrington, J., ... Dayton, M. T. (2005). Complicated diverticulitis: Is it time to rethink the rules? Annals of Surgery, 242(4), 576-583. https://doi.org/10.1097/01.sla.0000184843.89836.35

Complicated diverticulitis : Is it time to rethink the rules? / Chapman, Jennifer; Davies, Michael; Wolff, Bruce; Dozois, Eric; Tessier, Deron; Harrington, Jeffrey; Larson, Dirk; Fry, Robert D.; Dayton, Merril T.

In: Annals of Surgery, Vol. 242, No. 4, 01.10.2005, p. 576-583.

Research output: Contribution to journalArticle

Chapman, J, Davies, M, Wolff, B, Dozois, E, Tessier, D, Harrington, J, Larson, D, Fry, RD & Dayton, MT 2005, 'Complicated diverticulitis: Is it time to rethink the rules?', Annals of Surgery, vol. 242, no. 4, pp. 576-583. https://doi.org/10.1097/01.sla.0000184843.89836.35
Chapman, Jennifer ; Davies, Michael ; Wolff, Bruce ; Dozois, Eric ; Tessier, Deron ; Harrington, Jeffrey ; Larson, Dirk ; Fry, Robert D. ; Dayton, Merril T. / Complicated diverticulitis : Is it time to rethink the rules?. In: Annals of Surgery. 2005 ; Vol. 242, No. 4. pp. 576-583.
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abstract = "Introduction: Much of our knowledge and treatment of complicated diverticulitis (CD) are based on outdated literature reporting mortality rates of 10{\%}. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce morbidity and mortality. The aim of this study is to update our understanding of the morbidity, mortality, characteristics, and outcomes of CD. Methods: Three hundred thirty-seven patients hospitalized for CD were retrospectively analyzed. Characteristics and outcomes were determined using chi-squared and Fisher exact tests. Results: Mean age of patients was 65 years. Seventy percent had one or more comorbidities. A total of 46.6{\%} had a history of at least one prior diverticulitis episode, whereas 53.4{\%} presented with CD as their first episode. Overall mortality rate was 6.5{\%} (86.4{\%} associated with perforation, 9.5{\%} anastomotic leak, 4.5{\%} patient managed nonoperatively). A total of 89.5{\%} of the perforation patients who died had no history of diverticulitis. Steroid use was significantly associated with perforation rates as well as mortality (P < 0.001 and P = 0.002). Comorbidities such as diabetes, collagen-vascular disease, and immune system compromise were also highly associated with death (P = 0.006, P = 0.009, and P = 0.003, respectively). Overall morbidity was 41.4{\%}. Older age, gender, steroids, comorbidities, and perforation were significantly associated with morbidity. Conclusion: Today, mortality from CD excluding perforation is reduced compared with past data. This, coupled with the fact that the majority of these patients presented with CD as their first episode, calls into question the current practice of elective resection as a stratagem for reducing mortality. Immunocompromised patients may benefit from early resection. New prospective data is needed to redefine target groups for prophylactic resection.",
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N2 - Introduction: Much of our knowledge and treatment of complicated diverticulitis (CD) are based on outdated literature reporting mortality rates of 10%. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce morbidity and mortality. The aim of this study is to update our understanding of the morbidity, mortality, characteristics, and outcomes of CD. Methods: Three hundred thirty-seven patients hospitalized for CD were retrospectively analyzed. Characteristics and outcomes were determined using chi-squared and Fisher exact tests. Results: Mean age of patients was 65 years. Seventy percent had one or more comorbidities. A total of 46.6% had a history of at least one prior diverticulitis episode, whereas 53.4% presented with CD as their first episode. Overall mortality rate was 6.5% (86.4% associated with perforation, 9.5% anastomotic leak, 4.5% patient managed nonoperatively). A total of 89.5% of the perforation patients who died had no history of diverticulitis. Steroid use was significantly associated with perforation rates as well as mortality (P < 0.001 and P = 0.002). Comorbidities such as diabetes, collagen-vascular disease, and immune system compromise were also highly associated with death (P = 0.006, P = 0.009, and P = 0.003, respectively). Overall morbidity was 41.4%. Older age, gender, steroids, comorbidities, and perforation were significantly associated with morbidity. Conclusion: Today, mortality from CD excluding perforation is reduced compared with past data. This, coupled with the fact that the majority of these patients presented with CD as their first episode, calls into question the current practice of elective resection as a stratagem for reducing mortality. Immunocompromised patients may benefit from early resection. New prospective data is needed to redefine target groups for prophylactic resection.

AB - Introduction: Much of our knowledge and treatment of complicated diverticulitis (CD) are based on outdated literature reporting mortality rates of 10%. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce morbidity and mortality. The aim of this study is to update our understanding of the morbidity, mortality, characteristics, and outcomes of CD. Methods: Three hundred thirty-seven patients hospitalized for CD were retrospectively analyzed. Characteristics and outcomes were determined using chi-squared and Fisher exact tests. Results: Mean age of patients was 65 years. Seventy percent had one or more comorbidities. A total of 46.6% had a history of at least one prior diverticulitis episode, whereas 53.4% presented with CD as their first episode. Overall mortality rate was 6.5% (86.4% associated with perforation, 9.5% anastomotic leak, 4.5% patient managed nonoperatively). A total of 89.5% of the perforation patients who died had no history of diverticulitis. Steroid use was significantly associated with perforation rates as well as mortality (P < 0.001 and P = 0.002). Comorbidities such as diabetes, collagen-vascular disease, and immune system compromise were also highly associated with death (P = 0.006, P = 0.009, and P = 0.003, respectively). Overall morbidity was 41.4%. Older age, gender, steroids, comorbidities, and perforation were significantly associated with morbidity. Conclusion: Today, mortality from CD excluding perforation is reduced compared with past data. This, coupled with the fact that the majority of these patients presented with CD as their first episode, calls into question the current practice of elective resection as a stratagem for reducing mortality. Immunocompromised patients may benefit from early resection. New prospective data is needed to redefine target groups for prophylactic resection.

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