What are the differences between the three most used classifications for acute colonic diverticulitis? A comparative multicenter study: Acute diverticulitis classifications comparison.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
16 Oct 2023
16 Oct 2023
Historique:
pubmed:
4
9
2023
medline:
4
9
2023
entrez:
4
9
2023
Statut:
aheadofprint
Résumé
Acute left-sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. Currently, the most popular classifications, based on radiological findings, are the modified Hinchey, AAST, and WSES classifications. We hypothesize that all classifications are equivalent in predicting outcomes. This is a retrospective study of 597 patients from four medical centers between 2014 and 2021. Based on clinical, radiological, and intraoperative findings, patients were graded according to the three classifications. Regression analysis and receiver operating characteristic curve analysis were used to compare six outcomes: need for intervention, complications, major complications (Clavien-Dindo >2), reintervention, hospital length of stay, and mortality. A total of 597 patients were included. Need for intervention, morbidity, and reintervention rates significantly increased with increasing AAST, modified Hinchey, and WSES grades. The area under the curve (AUC) for the need for intervention was 0.84 for AAST and 0.81 for modified Hinchey ( p = 0.039). The AUC for major complications was 0.75 for modified Hinchey and 0.70 for WSES ( p = 0.009). No differences were found between the three classifications when comparing AUCs for mortality, complications, and reintervention rates. The AAST, WSES, and modified Hinchey classifications are similar in predicting complications, reintervention, and mortality rates. AAST and modified Hinchey scores result the most adequate for predicting the need for surgery and the occurrence of major complications. Prognostic and epidemiological study, level III.
Sections du résumé
BACKGROUND
BACKGROUND
Acute left-sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. Currently, the most popular classifications, based on radiological findings, are the modified Hinchey, AAST, and WSES classifications. We hypothesize that all classifications are equivalent in predicting outcomes.
METHODS
METHODS
This is a retrospective study of 597 patients from four medical centers between 2014 and 2021. Based on clinical, radiological, and intraoperative findings, patients were graded according to the three classifications. Regression analysis and receiver operating characteristic curve analysis were used to compare six outcomes: need for intervention, complications, major complications (Clavien-Dindo >2), reintervention, hospital length of stay, and mortality.
RESULTS
RESULTS
A total of 597 patients were included. Need for intervention, morbidity, and reintervention rates significantly increased with increasing AAST, modified Hinchey, and WSES grades. The area under the curve (AUC) for the need for intervention was 0.84 for AAST and 0.81 for modified Hinchey ( p = 0.039). The AUC for major complications was 0.75 for modified Hinchey and 0.70 for WSES ( p = 0.009). No differences were found between the three classifications when comparing AUCs for mortality, complications, and reintervention rates.
CONCLUSION
CONCLUSIONS
The AAST, WSES, and modified Hinchey classifications are similar in predicting complications, reintervention, and mortality rates. AAST and modified Hinchey scores result the most adequate for predicting the need for surgery and the occurrence of major complications.
LEVEL OF EVIDENCE
METHODS
Prognostic and epidemiological study, level III.
Identifiants
pubmed: 37661307
doi: 10.1097/TA.0000000000004133
pii: 01586154-990000000-00487
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.
Déclaration de conflit d'intérêts
CONFLICT OF INTEREST DISCLOSURE: All JTACS Disclosure forms have been supplied and are provided as supplemental digital content ( http://links.lww.com/TA/D243 ).