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Risk of Emergency Surgery or Death After Initial Nonoperative Management of Complicated Diverticulitis in Scotland
Marco von Strauss Und Torney1,2, Giusi Moffa3, Max Kaech1
1Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland.
JAMA Surgery
|May 14, 2020
Summary
Routine interval colonic resection after complicated diverticulitis did not reduce adverse outcomes like emergency surgery or death. This finding challenges current guidelines recommending resection to prevent recurrence.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Public Health
Background:
- Guidelines for interval colonic resection after complicated diverticulitis vary internationally.
- US and German guidelines recommend resection, while UK guidelines do not.
Purpose of the Study:
- To compare patient outcomes after nonoperative management of complicated diverticulitis in Switzerland and Scotland.
- To determine if interval resection impacts disease-specific emergency surgery or death rates.
Main Methods:
- Secondary analysis of national inpatient data from Switzerland and Scotland (2005-2015).
- Inclusion of patients with successfully nonoperatively managed complicated diverticulitis.
- Comparison of adverse outcomes (emergency surgery or inpatient death) between countries with differing resection rates.
Main Results:
- No significant difference in adverse outcomes (5.0% in both countries) despite a 5-fold difference in interval resection rates.
- Elective interval colonic resection was performed in 23.7% of Swiss patients vs. 4.5% of Scottish patients.
- Comorbidity was the only significant confounder associated with outcomes.
Conclusions:
- Interval colonic resection rates vary significantly between Switzerland and Scotland.
- No evidence suggests interval resection improves outcomes for complicated diverticulitis.
- Findings question the routine use of interval resection for preventing recurrence.
