| Title: |
Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group |
| Authors: |
Ocaña Jiménez, Juan; García Pérez, Juan Carlos; Fernández Martínez, Daniel; Aguirre Allende, Ignacio; Pascual Migueláñez, Isabel; Lora Cumplido, Paola; Espín Basany, Eloy; Labalde Martínez, María; León, Carmen; Pastor Peinado, Paula; López Domínguez, Carlota; Muñoz Plaza, Nerea; Valle Rubio, Ainhoa; Dujovne Lindenbaum, Paula; Alías Jiménez, David; Pérez Santiago, Leticia; Correa Bonito, Alba; Carmona Agúndez, María; Fernández Cebrián, José María; Die Trill, Francisco Javier |
| Contributors: |
The DIPLICAB Study Collaborative Group; Universidad de Alcalá. Departamento de Cirugía, Ciencias Médicas y Sociales; Unidad Docente Cirugía |
| Publication Year: |
2023 |
| Collection: |
e_Buah - Biblioteca Digital de la Universidad de Alcalá |
| Subject Terms: |
Diverticulitis; Immunosuppressed; Non-operative management; Medicina; Medicine |
| Description: |
10 p. ; Aim: Management of diverticulitis with abscess formation in immunosuppressed patients (IMS) remains unclear. The main objective of the study was to assess short- and long-term outcomes between IMS and immunocompetent patients (IC). The secondary aim was to identify risk factors for emergency surgery. Methods: A nationwide retrospective cohort study was performed at 29 Spanish referral centres between 2015-2019 including consecutive patients with first episode of diverticulitis classified as modified Hinchey Ib or II. IMS included immunosuppressive therapy, biologic therapy, malignant neoplasm with active chemotherapy and chronic steroid therapy. A multivariate analysis was performed to identify independent risk factors to emergency surgery in IMS. Results: A total of 1395 patients were included; 118 IMS and 1277 IC. There were no significant differences in emergency surgery between IMS and IC (19.5% and 13.5%, p = 0.075) but IMS was associated with higher mortality (15.1% vs. 0.6%, p < 0.001). Similar recurrent episodes were found between IMS and IC (28% vs. 28.2%, p = 0.963). Following multivariate analysis, immunosuppressive treatment, p = 0.002; OR: 3.35 (1.57-7.15), free gas bubbles, p < 0.001; OR: 2.91 (2.01-4.21), Hinchey II, p = 0.002; OR: 1.88 (1.26-2.83), use of morphine, p < 0.001; OR: 3.08 (1.98-4.80), abscess size ?5 cm, p = 0.001; OR: 1.97 (1.33-2.93) and leucocytosis at third day, p < 0.001; OR: 1.001 (1.001-1.002) were independently associated with emergency surgery in IMS. Conclusion: Nonoperative management in IMS has been shown to be safe with similar treatment failure than IC. IMS presented higher mortality in emergency surgery and similar rate of recurrent diverticulitis than IC. Identifying risk factors to emergency surgery may anticipate emergency surgery. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| ISSN: |
38010046 |
| Relation: |
https://hdl.handle.net/10017/64435; AR/0000050103; Colorectal Disease; 26; 129; 120 |
| DOI: |
10.1111/codi.16810 |
| Availability: |
https://hdl.handle.net/10017/64435; https://doi.org/10.1111/codi.16810 |
| Rights: |
© 2023 Association of Coloproctology of Great Britain and Ireland ; Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ; http://creativecommons.org/licenses/by-nc-nd/4.0/ ; info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.9C8EB25D |
| Database: |
BASE |