Emergency surgery for acute diverticulitis: Which operation? A national surgical quality improvement program study

Mathew D. Tadlock, Efstathios Karamanos, Dimitra Skiada, Kenji Inaba, Peep Talving, Anthony Senagore, Demetrios Demetriades

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND: The optimal surgical management of acute diverticulitis is still a controversial and unresolved issue. While the Hartmann's procedure (') is the most commonly performed operation, primary anastomosis (PA), with or without proximal diversion, has also been used with increasing frequency. METHODS: This is a National Surgical Quality Improvement Program database study including all patients requiring emergency surgery for acute diverticulitis. Three operative approaches were analyzed: HP, colectomy with PA, and colectomy with PA with proximal diversion (PAPD). Mortality and postoperative outcomes were compared between the three groups using a logistical regression model. RESULTS: There were 1,314 patients who required emergent operation for acute diverticulitis, 75.4% underwent HP, 21.7% underwent PA, and 2.9% underwent PAPD. Thirty-day mortality was 7.3%, 4.6%, and 1.6% for HP, PA, and PAPD respectively ( p = 0.163), while surgical site infections occurred in 19.7%, 17.9%, and 13.2%, respectively ( p = 0.59). After multivariable analysis adjusting for age, alcohol consumption, comorbidities, steroid use, preoperative laboratory values, hemorrhage at admission and laparoscopic surgery, the adjusted odds ratio for 30-day mortality comparing PA with HP was 0.77 (95% confidence interval [CI], 0.38Y1.56; p = 0.465), 0.47 (95% CI, 0.06Y3.74; p = 0.479) comparing PAPD with HP, and 1.62 (95% CI, 0.19Y13.78; p = 0.658) comparing PAwith PAPD. In addition, the three groups did not have significantly different adjusted odds ratio for the development of surgical infectious complications, acute kidney injury, cardiovascular incidents, or venous thromboembolism after surgery. CONCLUSION: Resection and PA in patients undergoing an emergency operation for acute diverticulitis is a safe alternative to the HP, with no significant difference in mortality or postoperative surgical site infections.LEVEL OF EVIDENCE: Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)1385-1391
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

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Diverticulitis
Quality Improvement
Emergencies
Surgical Wound Infection
Mortality
Colectomy
Confidence Intervals
Odds Ratio
Venous Thromboembolism
Acute Kidney Injury
Alcohol Drinking
Laparoscopy
Comorbidity
Steroids
Databases
Hemorrhage
Therapeutics

Keywords

  • Acute diverticulitis
  • Hartmann's procedure
  • Primary anastomosis
  • Proximal diversion

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Emergency surgery for acute diverticulitis : Which operation? A national surgical quality improvement program study. / Tadlock, Mathew D.; Karamanos, Efstathios; Skiada, Dimitra; Inaba, Kenji; Talving, Peep; Senagore, Anthony; Demetriades, Demetrios.

In: Journal of Trauma and Acute Care Surgery, Vol. 74, No. 6, 06.2013, p. 1385-1391.

Research output: Contribution to journalArticle

Tadlock, MD, Karamanos, E, Skiada, D, Inaba, K, Talving, P, Senagore, A & Demetriades, D 2013, 'Emergency surgery for acute diverticulitis: Which operation? A national surgical quality improvement program study', Journal of Trauma and Acute Care Surgery, vol. 74, no. 6, pp. 1385-1391. https://doi.org/10.1097/TA.0b013e3182924a82
Tadlock, Mathew D. ; Karamanos, Efstathios ; Skiada, Dimitra ; Inaba, Kenji ; Talving, Peep ; Senagore, Anthony ; Demetriades, Demetrios. / Emergency surgery for acute diverticulitis : Which operation? A national surgical quality improvement program study. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 74, No. 6. pp. 1385-1391.
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abstract = "BACKGROUND: The optimal surgical management of acute diverticulitis is still a controversial and unresolved issue. While the Hartmann's procedure (') is the most commonly performed operation, primary anastomosis (PA), with or without proximal diversion, has also been used with increasing frequency. METHODS: This is a National Surgical Quality Improvement Program database study including all patients requiring emergency surgery for acute diverticulitis. Three operative approaches were analyzed: HP, colectomy with PA, and colectomy with PA with proximal diversion (PAPD). Mortality and postoperative outcomes were compared between the three groups using a logistical regression model. RESULTS: There were 1,314 patients who required emergent operation for acute diverticulitis, 75.4{\%} underwent HP, 21.7{\%} underwent PA, and 2.9{\%} underwent PAPD. Thirty-day mortality was 7.3{\%}, 4.6{\%}, and 1.6{\%} for HP, PA, and PAPD respectively ( p = 0.163), while surgical site infections occurred in 19.7{\%}, 17.9{\%}, and 13.2{\%}, respectively ( p = 0.59). After multivariable analysis adjusting for age, alcohol consumption, comorbidities, steroid use, preoperative laboratory values, hemorrhage at admission and laparoscopic surgery, the adjusted odds ratio for 30-day mortality comparing PA with HP was 0.77 (95{\%} confidence interval [CI], 0.38Y1.56; p = 0.465), 0.47 (95{\%} CI, 0.06Y3.74; p = 0.479) comparing PAPD with HP, and 1.62 (95{\%} CI, 0.19Y13.78; p = 0.658) comparing PAwith PAPD. In addition, the three groups did not have significantly different adjusted odds ratio for the development of surgical infectious complications, acute kidney injury, cardiovascular incidents, or venous thromboembolism after surgery. CONCLUSION: Resection and PA in patients undergoing an emergency operation for acute diverticulitis is a safe alternative to the HP, with no significant difference in mortality or postoperative surgical site infections.LEVEL OF EVIDENCE: Therapeutic study, level IV.",
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N2 - BACKGROUND: The optimal surgical management of acute diverticulitis is still a controversial and unresolved issue. While the Hartmann's procedure (') is the most commonly performed operation, primary anastomosis (PA), with or without proximal diversion, has also been used with increasing frequency. METHODS: This is a National Surgical Quality Improvement Program database study including all patients requiring emergency surgery for acute diverticulitis. Three operative approaches were analyzed: HP, colectomy with PA, and colectomy with PA with proximal diversion (PAPD). Mortality and postoperative outcomes were compared between the three groups using a logistical regression model. RESULTS: There were 1,314 patients who required emergent operation for acute diverticulitis, 75.4% underwent HP, 21.7% underwent PA, and 2.9% underwent PAPD. Thirty-day mortality was 7.3%, 4.6%, and 1.6% for HP, PA, and PAPD respectively ( p = 0.163), while surgical site infections occurred in 19.7%, 17.9%, and 13.2%, respectively ( p = 0.59). After multivariable analysis adjusting for age, alcohol consumption, comorbidities, steroid use, preoperative laboratory values, hemorrhage at admission and laparoscopic surgery, the adjusted odds ratio for 30-day mortality comparing PA with HP was 0.77 (95% confidence interval [CI], 0.38Y1.56; p = 0.465), 0.47 (95% CI, 0.06Y3.74; p = 0.479) comparing PAPD with HP, and 1.62 (95% CI, 0.19Y13.78; p = 0.658) comparing PAwith PAPD. In addition, the three groups did not have significantly different adjusted odds ratio for the development of surgical infectious complications, acute kidney injury, cardiovascular incidents, or venous thromboembolism after surgery. CONCLUSION: Resection and PA in patients undergoing an emergency operation for acute diverticulitis is a safe alternative to the HP, with no significant difference in mortality or postoperative surgical site infections.LEVEL OF EVIDENCE: Therapeutic study, level IV.

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