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Evaluation of the Risk of a Nonrestorative Resection for the Treatment of Diverticular Disease: The Cleveland Clinic Diverticular Disease Propensity Score

  • Published:
Diseases of the Colon & Rectum

Purpose

The choice of operation for diverticular disease is a contentious issue, particularly in patients with acute symptoms. This study compares early outcomes between primary resection and anastomosis and Hartmann's resection and describes a propensity score for the selection of patients for nonrestorative procedures.

Methods

Data were collected from 731 patients undergoing primary resection and anastomosis (Group 1) and 123 patients undergoing primary Hartmann's resection (Group 2) for diverticular disease in a single tertiary referral center from January 1981 to May 2003. Multifactorial logistic regression was used to develop a propensity score for estimating the likelihood of performing a nonrestorative procedure.

Results

Operative 30-day mortality and surgical or medical complications were 0.7 percent, 26.0 percent, and 4.8 percent for primary resection and anastomosis and 12 percent, 43.9 percent, and 14.6 percent for Hartmann's resection, respectively (P < 0.001). There was no difference in the readmission rates between primary resection and anastomosis and Hartmann's resection (7.6 percent vs. 9.9 percent, P = 0.428). Laparoscopy was used for 32.7 percent of primary resection and anastomosis vs. 1.6 percent for Hartmann's resection (P < 0.001). Independentpredictors in favor for Hartmann's resection were body mass index ≥30 kg/m2 (odd's ratio = 2.32), Mannheim peritonitis index >10 (odd's ratio = 6.75), operative urgency (emergency, urgent vs. elective surgery, odd's ratio = 16.08vs. 13.32), and Hinchey stage >II (odd's ratio = 27.82). The area under the receiver operating characteristic curve for the choice of operative procedure was 93.9 percent.

Conclusions

Although Hartmann's resection was associated with a higher incidence of postoperative adverse events, the choice of operation was dependent on the patient presentation and intra-abdominal contamination, which can be quantified in the preoperative setting by the Cleveland Clinic diverticulitis propensity score.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA

    H. Nail Aydin M.D., Paris P. Tekkis M.D., Feza H. Remzi M.D. & Victor W. Fazio M.B.M.S.

  2. Department of Surgical Oncology and Technology, St. Mary's Hospital, Imperial College London, London, United Kingdom

    Paris P. Tekkis M.D. & Vasilis Constantinides M.B.B.S.

  3. Department of Colorectal Surgery/A30, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, 44195, USA

    Feza H. Remzi M.D.

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  1. H. Nail Aydin M.D.
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  2. Paris P. Tekkis M.D.
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  3. Feza H. Remzi M.D.
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  4. Vasilis Constantinides M.B.B.S.
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Correspondence to Feza H. Remzi M.D..

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Aydin, H.N., Tekkis, P.P., Remzi, F.H. et al. Evaluation of the Risk of a Nonrestorative Resection for the Treatment of Diverticular Disease: The Cleveland Clinic Diverticular Disease Propensity Score. Dis Colon Rectum 49, 629–639 (2006). https://doi.org/10.1007/s10350-006-0526-1

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  • DOI: https://doi.org/10.1007/s10350-006-0526-1

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