Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis

Isacson, Daniel; Smedh, K.; Nikberg, Maziar; Chabok, Abbas

doi:10.1002/bjs.11239

Cited by 65 publications

(59 citation statements)

References 17 publications

(20 reference statements)

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“…In general, the treatment of diverticulitis has shifted towards less aggressive approaches, which might also have beneficial effects on associated costs 31 . The avoidance of antibiotics for uncomplicated diverticulitis has been proven to be safe in both the short and long term [32][33][34][35] . The role of percutaneous drainage for diverticulitis with abscess formation has been debated 36,37 .…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial

Lambrichts

Bemelman²,

Lange

2020

British Journal of Surgery

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Background: Several studies have been published favouring sigmoidectomy with primary anastomosis over Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis (Hinchey grade III or IV), but cost-related outcomes were rarely reported. The present study aimed to evaluate costs and cost-effectiveness within the DIVA arm of the Ladies trial. Methods: This was a cost-effectiveness analysis of the DIVA arm of the multicentre randomized Ladies trial, comparing primary anastomosis over Hartmann's procedure for Hinchey grade III or IV diverticulitis. During 12-month follow-up, data on resource use, indirect costs (Short Form Health and Labour Questionnaire) and quality of life (EuroQol Five Dimensions) were collected prospectively, and analysed according to the modified intention-to-treat principle. Main outcomes were incremental cost-effectiveness (ICER) and cost-utility (ICUR) ratios, expressed as the ratio of incremental costs and the incremental probability of being stoma-free or incremental quality-adjusted life-years respectively. Results: Overall, 130 patients were included, of whom 64 were allocated to primary anastomosis (46 and 18 with Hinchey III and IV disease respectively) and 66 to Hartmann's procedure (46 and 20 respectively). Overall mean costs per patient were lower for primary anastomosis (€20 544, 95 per cent c.i. 19 569 to 21 519) than Hartmann's procedure (€28 670, 26 636 to 30 704), with a mean difference of €-8126 (-14 660 to-1592). The ICER was €-39 094 (95 per cent bias-corrected and accelerated (BCa) c.i.-1213 to-116), indicating primary anastomosis to be more cost-effective. The ICUR was €-101 435 (BCa c.i.-1 113 264 to 251 840). Conclusion: Primary anastomosis is more cost-effective than Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial

Lambrichts

Bemelman²,

Lange

2020

British Journal of Surgery

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“…It is useful for classifying both acute uncomplicated and complicated diverticulitis although there is little validation. Two randomized clinical trials (AVOD [84,85] and DIABOLO [71,86] antibiotic and nonantibiotic treatment in immunocompetent and nonseptic patients with uncomplicated acute diverticulitis. No differences in time to recovery from the initial episode or in hospital stay were seen in the two trials (Data S3; 3.1).…”

Section: Which Ct Classification Is Appropriate?mentioning

confidence: 99%

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

172

177

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Aim The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.

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“…A Twitter poll showed that despite recent studies showing that antibiotics are unnecessary for uncomplicated diverticulitis the majority still prescribe antibiotics in this context.…”

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confidence: 99%

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Grossman

2020

Journal of British Surgery

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Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis

Cited by 65 publications

References 17 publications

Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial

Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

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