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Uncomplicated Acute Diverticulitis: Identifying Risk Factors for Severe Outcomes

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Abstract

Background

The management of uncomplicated (Modified Hinchey Classification Ia) acute diverticulitis (AD) has become increasingly conservative, with a focus on symptomatic relief and supportive management. Clear criteria for patient selection are required to implement this safely. This retrospective study aimed to identify risk factors for severe clinical course in patients with uncomplicated AD.

Materials and methods

Patients admitted to General Surgery at two New Zealand tertiary centres over a period of 18 months were included. Univariate and multivariate analyses were carried out in order to identify factors associated with a more severe clinical course. This was defined by three endpoints: need for procedural intervention, admission >7 days and 30-day readmission; these were analysed separately and as a combined outcome.

Results

Uncomplicated AD was identified in 319 patients. Fifteen patients (5%) required procedural intervention; this was associated with SIRS (OR 3.92). Twenty-two (6.9%) patients were admitted for >7 days; this was associated with patient-reported pain score >8/10 (OR 5.67). Thirty-one patients (9.8%) required readmission within 30 days; this was associated with pain score >8/10 (OR 6.08) and first episode of AD (OR 2.47). Overall, 49 patients had a severe clinical course, and associated factors were regular steroid/immunomodulator use (OR 4.34), pain score >8/10 (OR 5.9) and higher temperature (OR 1.51) and CRP ≥200 (OR 4.1).

Conclusion

SIRS, high pain score and CRP, first episode and regular steroid/immunomodulator use were identified as predictors of worse outcome in uncomplicated AD. These findings have the potential to inform prospective treatment decisions in this patient group.

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Acknowledgements

RJ is funded through a Doctoral Scholarship provided by the Auckland Medical Research Foundation (Reference No. 1214005).

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Authors and Affiliations

  1. Department of Surgery, University of Auckland, ACH Support Building, Park Road, Grafton, Auckland, New Zealand

    Rebekah Jaung, Jason P. Robertson, Ryash Vather, Andrew D. MacCormick & Ian P. Bissett

  2. Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland, New Zealand

    Malsha Kularatna

  3. Department of Gastroenterology and Hepatology, Auckland City Hospital, Auckland, New Zealand

    David Rowbotham

  4. Department of Surgery, Counties Manukau Health, Auckland, New Zealand

    Andrew D. MacCormick

  5. Department of Surgery, Auckland City Hospital, Auckland, New Zealand

    Ian P. Bissett

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  1. Rebekah Jaung
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  2. Malsha Kularatna
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  3. Jason P. Robertson
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  4. Ryash Vather
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Correspondence to Ian P. Bissett.

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Jaung, R., Kularatna, M., Robertson, J.P. et al. Uncomplicated Acute Diverticulitis: Identifying Risk Factors for Severe Outcomes. World J Surg 41, 2258–2265 (2017). https://doi.org/10.1007/s00268-017-4012-9

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  • DOI: https://doi.org/10.1007/s00268-017-4012-9

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