Trends in emergent diverticular disease management: a nationwide cohort study from 2009 to 2018

Martellotto, Sophie; Challine, Alexandre; Peveri, V.; Paolino, Luca; Lazzati, Andrea

doi:10.1007/s10151-021-02423-w

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…It was based on an administrative database using classification of disease (ICD-10) codes, rather than on clinical data. Although ICD codes can be extremely accurate, they are not always consistent with clinical classification; for instance, there is no correlation between the Hinchey classification for perforated diverticulitis and ICD codes 21 . The use of a standardized classification does, however, facilitate reproducibility and comparison.…”

Section: Discussionmentioning

confidence: 99%

“…The pandemic coupled with a national lockdown had a massive impact on emergency operations, especially in zones with a higher prevalence of COVID-19 infection, where in-hospital mortality increased significantly. Although the surgical community has the ability to adapt and cope with emerging viral infections, such as the human immunodeficiency virus and severe acute respiratory syndrome 21 , it is essential that health authorities act to preserve an adequate workforce, prevent scarcity of resources, and continue to deliver appropriate messages to the public in order to maintain adequate surgical services.…”

Section: Discussionmentioning

confidence: 99%

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Impact of COVID-19 on surgical emergencies: nationwide analysis

et al. 2021

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Background The COVID-19 pandemic has had a major impact on healthcare in many countries. This study assessed the effect of a nationwide lockdown in France on admissions for acute surgical conditions and the subsequent impact on postoperative mortality. Methods This was an observational analytical study, evaluating data from a national discharge database that collected all discharge reports from any hospital in France. All adult patients admitted through the emergency department and requiring a surgical treatment between 17 March and 11 May 2020, and the equivalent period in 2019 were included. The primary outcome was the change in number of hospital admissions for acute surgical conditions. Mortality was assessed in the matched population, and stratified by region. Results During the lockdown period, 57 589 consecutive patients were admitted for acute surgical conditions, representing a decrease of 20.9 per cent compared with the 2019 cohort. Significant differences between regions were observed: the decrease was 15.6, 17.2, and 26.8 per cent for low-, intermediate- and high-prevalence regions respectively. The mortality rate was 1.92 per cent during the lockdown period and 1.81 per cent in 2019. In high-prevalence zones, mortality was significantly increased (odds ratio 1.22, 95 per cent c.i. 1.06 to 1.40). Conclusion A marked decrease in hospital admissions for surgical emergencies was observed during the lockdown period, with increased mortality in regions with a higher prevalence of COVID-19 infection. Health authorities should use these findings to preserve quality of care and deliver appropriate messages to the population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on surgical emergencies: nationwide analysis

et al. 2021

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“…Acute diverticulitis is the most common surgically treated disease after cancer; in the last three decades, the indications for surgical resection progressively reduced, in particular for the elective resection, and nowadays, elective surgery is considered only in the few cases with persistent symptoms and the risk of recurrent acute episodes in particular in young patients. Likewise, also, the indications for emergency surgery are quite restricted and limited to very selected cases (8.3%) [ 3 ] mostly for severe abdominal infective complications (41.62–79.4%) [ 4 , 5 ].…”

Section: Overviewmentioning

confidence: 99%

State-of-the-art surgery for sigmoid diverticulitis

Cirocchi

Sapienza

Anania

et al. 2021

Langenbecks Arch Surg

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Summary Background In the last two decades, there has been a Copernican revolution in the decision-making for the treatment of Diverticular Disease. Purpose This article provides a report on the state-of-the-art of surgery for sigmoid diverticulitis. Conclusion Acute diverticulitis is the most common reason for colonic resection after cancer; in the last decade, the indication for surgical resection has become more and more infrequent also in emergency. Currently, emergency surgery is seldom indicated, mostly for severe abdominal infective complications. Nowadays, uncomplicated diverticulitis is the most frequent presentation of diverticular disease and it is usually approached with a conservative medical treatment. Non-Operative Management may be considered also for complicated diverticulitis with abdominal abscess. At present, there is consensus among experts that the hemodynamic response to the initial fluid resuscitation should guide the emergency surgical approach to patients with severe sepsis or septic shock. In hemodynamically stable patients, a laparoscopic approach is the first choice, and surgeons with advanced laparoscopic skills report advantages in terms of lower postoperative complication rates. At the moment, the so-called Hartmann’s procedure is only indicated in severe generalized peritonitis with metabolic derangement or in severely ill patients. Some authors suggested laparoscopic peritoneal lavage as a bridge to surgery or also as a definitive treatment without colonic resection in selected patients. In case of hemodynamic instability not responding to fluid resuscitation, an initial damage control surgery seems to be more attractive than a Hartmann’s procedure, and it is associated with a high rate of primary anastomosis.

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“…Diverticular disease is a common condition for which the number of hospitalized patients has increased 1.6 times in the last decade [ 1 ]. Among diverticular diseases, Hinchey IIb-IV with sepsis is an urgent, life-threatening condition and 8% of patients require emergency surgery [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, the problem is that anastomotic leakage has been reported to occur in about 10% of simple PA without a stoma [ 8 , 10 ]. Under these circumstances, the simpler alternative, Hartmann procedure (HP), is still the most commonly performed procedure for left-sided diverticular perforation [ 1 , 16 ].…”

Section: Introductionmentioning

confidence: 99%