The Efficacy of Nonoperative Management of Acute Complicated Diverticulitis

Dharmarajan, Sekhar; Hunt, Steven R.; Birnbaum, Elisa H.; Fleshman, James W.; Mutch, Matthew G.

doi:10.1007/dcr.0b013e31820ef759

Cited by 179 publications

(179 citation statements)

References 18 publications

(13 reference statements)

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“…The multiple variable logistic regression analysis estimated odds ratios and 95% confidence intervals for days from admission for each outcome adjusted for confounders. The solution to the regression equation was used to predict the average probability of each outcome for each day following admission (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Average predicted values for each day were plotted to show the trend over 1 -20 days.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies have evaluated the effect of nonoperative measures on morbidity and mortality in patients with complicated diverticulitis. Non-operative management was found to have a 91% success rate when utilized on a cohort of patients who were hemodynamically stable with an associated abscess or free air in the absence of free fluid on CT scan (15). Those who failed non-operative therapy had a broad range of disease severity; 28.6% had pericolonic air without abscess, 14.3% had an abscess < 4 cm or < 2 cm collections of distant free air and 57.1% had an abscess > 4 cm or collections of distant free air > 2cm.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

et al. 2017

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Background: Ideal operative timing for non-emergent, acute diverticulitis (AD) remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy. Objectives: To evaluate the effect of operative delay on sepsis and mortality in patients with AD. Methods: Patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI), pneumonia (PNA), need for blood transfusion, septic shock, return to the operating room, length of stay (LOS), readmission, wound dehiscence, and surgical site infections (SSI). Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for primary and secondary outcomes. Results: 32,399 patients underwent colectomy for AD on hospital day 1 -20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 -1.057; P < 0.0001) and sepsis (OR = 1.051, 95% CI, 1.035 -1.067; P < 0.0001). Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion, return to the operating room and increased LOS. Conclusions: Delaying operation for patients with AD has a significant impact on sepsis and mortality. While non-operative approaches may be attempted, with each additional day operative therapy is delayed there is a significant increase in the risk of morbidity and mortality. This data suggests that surgeons should pursue operative therapy earlier in the hospital course to improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

et al. 2017

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“…However, CT findings of distant free air (a known predictor of failure of nonoperative treatment) does not necessarily obligate a surgical approach. Dharmarajan et al [82] described a high success rate for non-operative management in patients with acute diverticulitis and a pneumoperitoneum, excluding those with hemodynamic instability.…”

Section: Statementmentioning

confidence: 99%

Management of Intra-Abdominal Infections

Moore

2016

Common Problems in Acute Care Surgery

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This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.

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“…Olgular yaygın olarak yoğun bakım ünitelerinde özellikle akut dönem boyunca vital bulgular dikkatlice izlenmelidir. Son dönem iki tek merkez çalışmasında ciddi sepsis saptanmassa ameliyat yapılmaksızın medikal tedavi ile izlenebileceğini gösteren çalışmalar yayınlanmıştır (17,18) . Hinchey 2,3 grubundaki hastalara tıbbi tedaviye ek olarak bazı olgularda acil ameliyat edilmiştir.…”

Section: Hinchey 1-2 Hinchey 3-4 Toplamunclassified

The Diagnosis and Treatment Approach in Acute Colon Diverticulutis.

Emiroğlu¹,

Uğurlu²,

Karaalı³

et al. 2015

Tepecik Dergisi

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ÖZETAmaç: Akut karın oluşturan akut divertikülitin (AD) cerrahi kliniklerinde tanı ve tedavisi tartışmalıdır. Çalışmamızda, genel cerrahi kliniğimizde tedavi edilen sol kolon (inen kolon, siğmoid ve rektum) yerleşimli akut divertikülit olgularının tanı ve tedavi yaklaşımlarının incelenmesi amaçlandı. Yöntemler: Eylül 2007-Kasım 2014 tarihleri arasında sol kolon, sigmoid ve rektum yerleşimli AD nedeniyle hastenemiz genel cerrahi kliniğinde tedavi edilen hastalar değerlendirildi. Veriler hasta dosyaları ve Medülla (Probel A.Ş.) elektronik hasta kayıt sisteminden retrospektif olarak toplandı. Hastaların demografik, ek-morbidite, klinik yakınmaları, görüntüleme ve laboratuvar bulguları kaydedildi. Divertikülitlerin sol kolondaki dağılımı, tıbbi tedavi ve cerrahi tedavi verileri, yapılan ameliyatın tipi, hastanede yatış süresi ve morbidite-mortalite verileri incelendi. Hastalar Hinchey sınflamasına göre sınıflandırıldı ve gruplandırıldı. Bulgular: Toplam 35 hasta dâhil edilen çalışmamızdaki ortalama yaş 56 (29-78) yıl idi. Hinchey sınflandırılmasına göre 24 (%68,4) olgu Hinchey 1-2 ve 11 (%31,4) olgu Hinchey 3-4 olarak değerlendirilmiştir. Klinik olarak en sık yakınmanın otuziki (%91,4) olguda karın ağrısı olduğu saptandı. Otuz beş (%100) olguda karın tomografisi, otuz üç (%94,3) olguda karın ultrasonografisi yapıldığı bulundu. Kolonoskopi 22 (%62,9) olguda yapılmıştır. En sık olarak 31 (%88,6) olguda sigmoid kolon divertiküliti saptanmıştır. Tüm olguların %48,6'sına medikal tedavi uygulanmıştır. Elektif cerrahi girişim %11,4 olguda yapılmıştır. En sık uygulanan cerrahi işlem %48,6 oranında Hartmann prosedürü idi. Yedi olguda (%20) komplikasyon ve üç (%8,7) olguda mortalite izlendi. Sonuç: Akut divertikülit uygun olgularda (Hinchey 1,2) medikal tedavi ile tedavi edilebilir. Klinik ve görüntüleme bulgularında hastalığın ileri evresinde (Hinchey 3,4) olanlar için acil cerrahi girişim uygulanmalıdır. Tanı, tedavi ve tüm sürecinin izlenmesinde karın görüntüleme yöntemleri önemli bir rolü vardır. Anahtar kelimeler: Akut divertikülit, tanı ve tedavi ABSTRACTObjective: In our study we aimed to evaluate the treatment and diagnosis of the cases with acute diverticulitis of the left colon (descendant colon, sigmoid and rectum) who had been treated in our clinic. Methods: The patients with AD in the left colon, sigmoid ve rectum who were treated in general surgery clinic of our hospital September 2007 and November 2014 were evaluated. The data was obtained retrospectively. from patient files and medulla (Probel Corporation), and patients' electronical recording system Demographics, additional-morbidity, clinical complaints, imaging and laboratuary findings were recorded. The distribution of diverticulitis in the left colon, the data about treatment and surgical treatment, the type of performed operation, duration of hospitalization and the data about mortality and morbidity were recorded. The patients were classified and grouped according to Hinchey classification. Results: Totally 35 patients were included in our study and the...

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The Efficacy of Nonoperative Management of Acute Complicated Diverticulitis

Cited by 179 publications

References 18 publications

Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

Management of Intra-Abdominal Infections

The Diagnosis and Treatment Approach in Acute Colon Diverticulutis.

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