Emergency surgery for acute diverticulitis: which operation? A National Surgical Quality Improvement Program study

Area of Science:

• Colorectal surgery
• Surgical outcomes research
• Gastrointestinal disease management

Background:

• Optimal surgical management for acute diverticulitis remains debated.
• Hartmann's procedure (HP) is common, but primary anastomosis (PA) is increasingly used.
• PA may be performed with or without proximal diversion (PAPD).

Purpose of the Study:

• To compare mortality and postoperative outcomes of three surgical approaches for acute diverticulitis.
• To evaluate Hartmann's procedure (HP), primary anastomosis (PA), and PA with proximal diversion (PAPD).

Main Methods:

• Analysis of a National Surgical Quality Improvement Program database.
• Inclusion of patients undergoing emergency surgery for acute diverticulitis.
• Comparison of outcomes using logistic regression, adjusting for multiple patient and surgical factors.

Main Results:

• Hartmann's procedure (HP) was performed in 75.4% of 1,314 patients; PA in 21.7%; and PAPD in 2.9%.
• No statistically significant differences were found in 30-day mortality (HP: 7.3%, PA: 4.6%, PAPD: 1.6%) or surgical site infections (HP: 19.7%, PA: 17.9%, PAPD: 13.2%) between groups after multivariable analysis.
• Adjusted analyses showed no significant differences in mortality or infectious complications between PA and HP.

Conclusions:

• Resection with primary anastomosis (PA) is a safe alternative to Hartmann's procedure (HP) for emergency acute diverticulitis.
• No significant differences in mortality or postoperative surgical site infections were observed between PA and HP.