John Rose1, Ralitza P Parina, Omar Faiz, David C Chang, Mark A Talamini. 1. *Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA †Department of Surgery & Cancer, Imperial College, London, UK ‡Department of Surgery, Stony Brook Medicine, Stony Brook, NY.
Abstract
OBJECTIVE: This study aims to determine the long-term outcomes of diverticulitis and to apply the findings to current practice patterns. BACKGROUND: The long-term morbidity and mortality of diverticulitis are not well defined. Current practice guidelines for diverticulitis are based on limited evidence. METHODS: The California Office of Statewide Health Planning and Development database was queried for longitudinal observations across all hospitals from 1995 to 2009. Recurrence up to 15 years, medical versus surgical treatment, and mortality after recurrence were analyzed for patients after emergent admission for diverticulitis. RESULTS: Among the 210,268 patients admitted emergently with diverticulitis, 179,649 (85%) were managed medically at their index admission. Of these medically managed patients, 27,450 (16.3%) suffered a second diverticulitis episode. On multivariable analysis, predictors of mortality with recurrence included the following [hazard ratio (95% confidence interval)]: age more than 50 years [5.19, (3.05-8.29)]; previous tobacco use [1.40 (1.18-1.66)]; and complicated initial presentation with obstruction [1.33 (1.06-1.65)], abscess [2.18 (1.60-2.97)], peritonitis [3.14 (1.99-4.97)], sepsis [1.88 (1.29-2.73)], and fistula [3.50 (2.17-5.66)]. The mortality of delayed elective surgical intervention after the first episode of emergent diverticulitis was 0.3% compared to 4.6% for emergent resection during a second episode. CONCLUSIONS: Eighty-five percent of emergent diverticulitis patients do not recur after initial medical treatment. However, in view of significantly worse outcomes associated with diverticulitis recurrence, resection should be strongly considered for diverticulitis patients older than 50 years or those who present with a complicated clinical picture.
OBJECTIVE: This study aims to determine the long-term outcomes of diverticulitis and to apply the findings to current practice patterns. BACKGROUND: The long-term morbidity and mortality of diverticulitis are not well defined. Current practice guidelines for diverticulitis are based on limited evidence. METHODS: The California Office of Statewide Health Planning and Development database was queried for longitudinal observations across all hospitals from 1995 to 2009. Recurrence up to 15 years, medical versus surgical treatment, and mortality after recurrence were analyzed for patients after emergent admission for diverticulitis. RESULTS: Among the 210,268 patients admitted emergently with diverticulitis, 179,649 (85%) were managed medically at their index admission. Of these medically managed patients, 27,450 (16.3%) suffered a second diverticulitis episode. On multivariable analysis, predictors of mortality with recurrence included the following [hazard ratio (95% confidence interval)]: age more than 50 years [5.19, (3.05-8.29)]; previous tobacco use [1.40 (1.18-1.66)]; and complicated initial presentation with obstruction [1.33 (1.06-1.65)], abscess [2.18 (1.60-2.97)], peritonitis [3.14 (1.99-4.97)], sepsis [1.88 (1.29-2.73)], and fistula [3.50 (2.17-5.66)]. The mortality of delayed elective surgical intervention after the first episode of emergent diverticulitis was 0.3% compared to 4.6% for emergent resection during a second episode. CONCLUSIONS: Eighty-five percent of emergent diverticulitispatients do not recur after initial medical treatment. However, in view of significantly worse outcomes associated with diverticulitis recurrence, resection should be strongly considered for diverticulitispatients older than 50 years or those who present with a complicated clinical picture.
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