Diverticulitis with abscess formation: Outcomes of non-operative management and nomogram for predicting emergency surgery: The Diplicab Study Collaborative Group.

Humans Abscess / surgery Retrospective Studies Abdominal Abscess / etiology Nomograms Diverticulitis / surgery Drainage / adverse effects

Journal

Surgery

ISSN: 1532-7361

Titre abrégé: Surgery

Pays: United States

ID NLM: 0417347

Informations de publication

Date de publication:
09 2023

Historique:

received: 30 01 2023

revised: 02 05 2023

accepted: 24 05 2023

medline: 8 8 2023

pubmed: 30 6 2023

entrez: 29 6 2023

Statut: ppublish

Résumé

To assess short- and long-term outcomes from non-surgical management of diverticulitis with abscess formation and to develop a nomogram to predict emergency surgery. This nationwide retrospective cohort study was performed in 29 Spanish referral centers, including patients with a first episode of a diverticular abscess (modified Hinchey Ib-II) from 2015 to 2019. Emergency surgery, complications, and recurrent episodes were analyzed. Regression analysis was used to assess risk factors, and a nomogram for emergency surgery was designed. Overall, 1,395 patients were included (1,078 Hinchey Ib and 317 Hinchey II). Most (1,184, 84.9%) patients were treated with antibiotics without percutaneous drainage, and 194 (13.90%) patients required emergency surgery during admission. Percutaneous drainage (208 patients) was associated with a lower risk of emergency surgery in patients with abscesses of ≥5 cm (19.9% vs 29.3%, P = .035; odds ratio 0.59 [0.37-0.96]). The multivariate analysis showed that immunosuppression treatment, C-reactive protein (odds ratio: 1.003; 1.001-1.005), free pneumoperitoneum (odds ratio: 3.01; 2.04-4.44), Hinchey II (odds ratio: 2.15; 1.42-3.26), abscess size 3 to 4.9 cm (odds ratio: 1.87; 1.06-3.29), abscess size ≥5 cm (odds ratio: 3.62; 2.08-6.32), and use of morphine (odds ratio: 3.68; 2.29-5.92) were associated with emergency surgery. A nomogram was developed with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.77-0.85). Percutaneous drainage must be considered in abscesses ≥5 cm to reduce emergency surgery rates; however, there are insufficient data to recommend it in smaller abscesses. The use of the nomogram could help the surgeon develop a targeted approach.

Sections du résumé

BACKGROUND

To assess short- and long-term outcomes from non-surgical management of diverticulitis with abscess formation and to develop a nomogram to predict emergency surgery.

METHODS

This nationwide retrospective cohort study was performed in 29 Spanish referral centers, including patients with a first episode of a diverticular abscess (modified Hinchey Ib-II) from 2015 to 2019. Emergency surgery, complications, and recurrent episodes were analyzed. Regression analysis was used to assess risk factors, and a nomogram for emergency surgery was designed.

RESULTS

Overall, 1,395 patients were included (1,078 Hinchey Ib and 317 Hinchey II). Most (1,184, 84.9%) patients were treated with antibiotics without percutaneous drainage, and 194 (13.90%) patients required emergency surgery during admission. Percutaneous drainage (208 patients) was associated with a lower risk of emergency surgery in patients with abscesses of ≥5 cm (19.9% vs 29.3%, P = .035; odds ratio 0.59 [0.37-0.96]). The multivariate analysis showed that immunosuppression treatment, C-reactive protein (odds ratio: 1.003; 1.001-1.005), free pneumoperitoneum (odds ratio: 3.01; 2.04-4.44), Hinchey II (odds ratio: 2.15; 1.42-3.26), abscess size 3 to 4.9 cm (odds ratio: 1.87; 1.06-3.29), abscess size ≥5 cm (odds ratio: 3.62; 2.08-6.32), and use of morphine (odds ratio: 3.68; 2.29-5.92) were associated with emergency surgery. A nomogram was developed with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.77-0.85).

CONCLUSION

Percutaneous drainage must be considered in abscesses ≥5 cm to reduce emergency surgery rates; however, there are insufficient data to recommend it in smaller abscesses. The use of the nomogram could help the surgeon develop a targeted approach.

Identifiants

DOI: 10.1016/j.surg.2023.05.016 PMID: 37385866

pubmed: 37385866

pii: S0039-6060(23)00311-2

doi: 10.1016/j.surg.2023.05.016

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

492-501

Investigateurs

None Araceli-Ballestero

Alfonso Muriel (A)

Ángel Luis Del Rey (ÁL)

Tamara Díaz (T)

María Del March Olmed (MDM)

Christian Nuño (C)

Miquel Craft (M)

Alfredo Vivas (A)

Pablo Peláez (P)

Isabel Alonso (I)

Ángela Santana (Á)

Manuel González-Bermúdez (M)

Cristina González-Prado (C)

Virginia Jiménez-Carneros (V)

Beatriz Laiz (B)

David Moro (D)

Livia Delgado (L)

Isabel Gallarín (I)

Cristina Vera (C)

Olga Delisau (O)

Blanca Montcusí (B)

Daniel Serralta (D)

Álvaro García-Granero (Á)

Pedro Antonio Parra (PA)

Francisco Mauri (F)

Raquel Ríos (R)

Pedro Abadía (P)

Eva María Torres (EM)

Giana Pamela Ibero (GP)

Ainhoa Echeveste-Varela (A)

Nuria Chavarrías (N)

Nuria Ortega-Torrecilla (N)

Eduardo Ferrero (E)

Eva Iglesias (E)

Michelle Otero (M)

Tamara Llamero (T)

César Lévano (C)

Ana Benitez (A)

Julia Revuelta (J)

María Inmaculada Lavado (MI)

Belén Matías (B)

Lidia Cornejo (L)

Anna Navarro (A)

José Alberto Rojo (JA)

Natalia Alonso (N)

Clara Giménez (C)

Alisa Ángela Diego (AÁ)

Cristian Pérez-González (C)

Eduardo de San Pío (E)

Patricia Ortega (P)

Javier López-Ruiz (J)