Diverticulitis with abscess formation: Outcomes of non-operative management and nomogram for predicting emergency surgery: The Diplicab Study Collaborative Group.
| Title: | Diverticulitis with abscess formation: Outcomes of non-operative management and nomogram for predicting emergency surgery: The Diplicab Study Collaborative Group. |
|---|---|
| Authors: | Ocaña J; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain. Electronic address: jocajim@gmail.com.; García-Pérez JC; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Fernández-Martínez D; Division of Coloproctology, Hospital Universitario Central de Asturias, Oviedo, Spain.; Aguirre I; Colorectal Surgery Unit, Hospital Universitario de Donostia, San Sebastián, Spain.; Pascual I; Colorectal Division, Hospital Universitario La Paz, Madrid, Spain.; Lora P; Colorectal Division, Hospital Univseristario Cabueñes, Gijón, Spain.; Espin E; Department of Colorectal Surgery, Hospital Universitari Vall d´Hebron, Universitat Autonoma de Barcelona, Spain.; Labalde-Martínez M; Division of Coloproctology, Hospital Universitario 12 de Octubre, Madrid, Spain.; León C; Division of Coloproctology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.; Pastor-Peinado P; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.; López-Domínguez C; Division of Coloproctology, Complejo Hospitalario Universitario A Coruña, Spain.; Muñoz-Plaza N; Division of Coloproctology, Hospital Universitario Burgos, Spain.; Valle A; Division of Coloproctology, Hospital Universitario de Getafe, Spain.; Dujovne P; Division of Coloproctology, Hospital Universitario Gregorio Marañón, Madrid, Spain.; Alías D; Unit of Coloproctology, Hospital Universitario Rey Juan Carlos, Móstoles, Spain.; Pérez-Santiago L; Division of Coloproctology, Hospital Clínico Universitario de Valencia, Spain.; Correa A; Unit of Coloproctology, Hospital Universitario La Princesa, Madrid, Spain.; Carmona M; Division of Coloproctology, Hospital Universitario de Badajoz, Spain.; Díez MM; Division of Coloproctology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain.; Timoteo A; Division of Coloproctology, Hospital Universitari Dr Josep Trueta, Gerona, Spain.; Salvans S; Division of Coloproctology, Hospital del Mar, Barcelona, Spain.; Medina RE; Division of Coloproctology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.; Gómez T; Division of Coloproctology, Hospital Universitario Puerta del Mar, Cádiz, Spain.; Fernández-Vega L; Division of Coloproctology, Hospital Universitari Son Espases, Palma, Spain.; Peña E; Division of Coloproctology, Hospital Universitario Reina Sofía, Murcia, Spain.; García-González JM; Division of Coloproctology, Hospital Universitario de Cruces, Barakaldo, Spain.; Blanco-Antona F; Division of Coloproctology, Hospital Universitario Salamanca, Spain.; Fábregues AI; Division of Coloproctology, Hospital Universitario Alicante, Spain.; Sagarra E; Division of Coloproctology, Hospital Universitario Infanta Cristina, Parla, Spain.; Viejo E; Division of Coloproctology, Hospital Universitario Infanta Leonor, Madrid, Spain.; Moreno A; Division of Coloproctology, Hospital Reina Sofía, Córdoba, Spain.; Fernández-Cebrián JM; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Die J; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain. |
| Corporate Authors: | DIPLICAB Study Collaborative Group |
| Source: | Surgery [Surgery] 2023 Sep; Vol. 174 (3), pp. 492-501. Date of Electronic Publication: 2023 Jun 27. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Mosby Country of Publication: United States NLM ID: 0417347 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-7361 (Electronic) Linking ISSN: 00396060 NLM ISO Abbreviation: Surgery Subsets: MEDLINE |
| Imprint Name(s): | Publication: St. Louis, MO : Mosby; Original Publication: St. Louis. |
| MeSH Terms: | Abdominal Abscess*/etiology ; Abdominal Abscess*/therapy ; Diverticulitis*/surgery; Abscess/surgery ; Abscess/complications ; Drainage/adverse effects ; Humans ; Retrospective Studies ; Nomograms |
| Abstract: | 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.; (Copyright © 2023 Elsevier Inc. All rights reserved.) |
| Contributed Indexing: | Investigator: Araceli-Ballestero; A Muriel; ÁL Del Rey; T Díaz; MDM Olmed; C Nuño; M Craft; A Vivas; P Peláez; I Alonso; Á Santana; M González-Bermúdez; C González-Prado; V Jiménez-Carneros; B Laiz; D Moro; L Delgado; I Gallarín; C Vera; O Delisau; B Montcusí; D Serralta; Á García-Granero; PA Parra; F Mauri; R Ríos; P Abadía; EM Torres; GP Ibero; A Echeveste-Varela; N Chavarrías; N Ortega-Torrecilla; E Ferrero; E Iglesias; M Otero; T Llamero; C Lévano; A Benitez; J Revuelta; MI Lavado; B Matías; L Cornejo; A Navarro; JA Rojo; N Alonso; C Giménez; AÁ Diego; C Pérez-González; E de San Pío; P Ortega; J López-Ruiz |
| Entry Date(s): | Date Created: 20230629 Date Completed: 20230808 Latest Revision: 20230808 |
| Update Code: | 20260130 |
| DOI: | 10.1016/j.surg.2023.05.016 |
| PMID: | 37385866 |
| Database: | MEDLINE |
Journal Article