Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group.

Autor: Ocaña J; Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain., 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-Basany E; Department of Colorectal Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 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, A Coruña, Spain., Muñoz-Plaza N; Division of Coloproctology, Hospital Universitario Burgos, Burgos, Spain., Valle A; Division of Coloproctology, Hospital Universitario de Getafe, 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, Valencia, Spain., Correa A; Unit of Coloproctology, Hospital Universitario La Princesa, Madrid, Spain., Carmona M; Division of Coloproctology, Hospital Universitario de Badajoz, Badajoz, 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.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2024 Jan; Vol. 26 (1), pp. 120-129. Date of Electronic Publication: 2023 Nov 27.
DOI: 10.1111/codi.16810
Abstrakt: 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.
(© 2023 Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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