John W Lorimer1, Gaby Doumit. 1. Department of Surgery, University of Ottawa, Room K-11, Ottawa Hospital/General Site, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6. jlorimer@ottawahospital.on.ca
Abstract
BACKGROUND: Acute colonic diverticulitis may be simple or very complicated. Not much is understood about what factors determine severity. Answering this question may have therapeutic implications. METHODS: A retrospective review was performed consisting of teaching hospital admissions for simple or complicated acute diverticulitis. The intent was to identify characteristics of and differences between the 2 groups. The Charlson index was used to assess states of preexisting health (comorbidity). RESULTS: In multivariate analysis, the presence of a major degree of comorbidity (Charlson score 3 or greater) was strongly associated with complicated disease (P = 0.02) as was the use of nonsteroidal anti-inflammatory drugs (P = .01). Deaths were not seen below age 50, and high Charlson score also strongly predicted mortality (P < .0001). CONCLUSIONS: There are significant differences between patients presenting with simple and complicated diverticulitis, and the amount of associated comorbidity (as measured by Charlson score) appears to be a major one. Because of the high mortality seen in patients with Charlson scores 3 or greater and complicated diverticulitis, we believe that an early surgical approach should be considered for them, particularly if they are 50 or older.
BACKGROUND: Acute colonic diverticulitis may be simple or very complicated. Not much is understood about what factors determine severity. Answering this question may have therapeutic implications. METHODS: A retrospective review was performed consisting of teaching hospital admissions for simple or complicated acute diverticulitis. The intent was to identify characteristics of and differences between the 2 groups. The Charlson index was used to assess states of preexisting health (comorbidity). RESULTS: In multivariate analysis, the presence of a major degree of comorbidity (Charlson score 3 or greater) was strongly associated with complicated disease (P = 0.02) as was the use of nonsteroidal anti-inflammatory drugs (P = .01). Deaths were not seen below age 50, and high Charlson score also strongly predicted mortality (P < .0001). CONCLUSIONS: There are significant differences between patients presenting with simple and complicated diverticulitis, and the amount of associated comorbidity (as measured by Charlson score) appears to be a major one. Because of the high mortality seen in patients with Charlson scores 3 or greater and complicated diverticulitis, we believe that an early surgical approach should be considered for them, particularly if they are 50 or older.
Authors: Guillaume Martel; Alexandre Bouchard; Claudia M Soto; Eric C Poulin; Joseph Mamazza; Robin P Boushey Journal: Surg Endosc Date: 2010-02-26 Impact factor: 4.584
Authors: Sun Young Kim; Tae Hoon Oh; Ji Young Seo; Tae Joo Jeon; Dong Dae Seo; Won Chang Shin; Won Choong Choi; Myeong Ja Jeong Journal: Gut Liver Date: 2012-01-12 Impact factor: 4.519