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Use of severity classification systems in the surgical decision-making process in emergency laparotomy for perforated diverticulitis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Hartman’s procedure (HP) or primary anastomosis (PA) are the two surgical techniques used in patients undergoing emergency colectomy for perforated diverticulitis. There are no objective criteria to guide the surgeon’s choice of procedure. This study assesses whether classification and scoring systems can be used in the decision-making process.

Methods

One hundred eleven patients undergoing emergency laparotomy for perforated diverticulitis were analyzed. Logistic regression and interaction models were used to determine the predictive value in the two settings.

Results

Sixty five patients underwent HP and 46 patients underwent PA. Patients with HP had significantly higher scores, median age, and were more often on immunosuppressive medication. Mortality and surgical morbidity did not differ between the groups. The clinical anastomotic leak rate was 28.3% in the PA group. In the univariate logistic regression for in-hospital death, all scores showed a significant influence. The multivariate logistic regression analysis showed that only Charlson comorbidity index (CCI) and American Society of Anesthesiologists score had a significant influence on mortality. Each score was analyzed for its predictive value regarding mortality and morbidity with respect to type of operative procedure. Only CCI revealed a trend towards statistical significance. The risk of death increases with increasing CCI when PA is performed compared to HP.

Conclusion

None of the tested scores can be used to help the surgeon decide whether a PA or HP is appropriate in a specific patient. Comorbidity, represented as CCI in this study, might be more important than the locoregional situation.

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Acknowledgments

The authors thank Dr. Robert Whitfield, MBBS, for assistance in preparing the manuscript in English. No financial support is disclosed by the authors.

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Authors and Affiliations

  1. Department of Surgery, Triemli Hospital, Birmensdorferstr. 497, 8063, Zurich, Switzerland

    Itai Pasternak, Michael Dietrich, Urs Metzger & Urs Zingg

  2. Department of General Practice, Flinders University, Bedford Park, 5042, SA, Australia

    Richard Woodman

  3. Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, 5042, SA, Australia

    David A. Wattchow & Urs Zingg

  4. Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia

    Urs Zingg

Authors
  1. Itai Pasternak
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  2. Michael Dietrich
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  3. Richard Woodman
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  4. Urs Metzger
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  5. David A. Wattchow
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  6. Urs Zingg
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Correspondence to Urs Zingg.

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Pasternak, I., Dietrich, M., Woodman, R. et al. Use of severity classification systems in the surgical decision-making process in emergency laparotomy for perforated diverticulitis. Int J Colorectal Dis 25, 463–470 (2010). https://doi.org/10.1007/s00384-009-0852-6

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  • DOI: https://doi.org/10.1007/s00384-009-0852-6

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