What are the differences between the three most used classifications for acute colonic diverticulitis? A comparative...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Epidemiology

Background:

• Acute left-sided colonic diverticulitis is a common surgical emergency.
• Current classifications (modified Hinchey, AAST, WSES) are based on radiological findings.
• This study evaluates the predictive equivalence of these classifications.

Purpose of the Study:

• To compare the efficacy of modified Hinchey, AAST, and WSES classifications in predicting outcomes of acute left-sided colonic diverticulitis.
• To determine which classification system is most accurate for surgical decision-making.

Main Methods:

• Retrospective study of 597 patients (2014-2021).
• Patients graded using modified Hinchey, AAST, and WSES classifications.
• Regression and ROC curve analyses compared prediction of intervention, complications, and mortality.

Main Results:

• All classifications showed increasing rates of intervention, morbidity, and reintervention with higher grades.
• AAST and modified Hinchey showed superior prediction for the need for intervention (AUC 0.84 and 0.81).
• Modified Hinchey and WSES showed better prediction for major complications (AUC 0.75 and 0.70).

Conclusions:

• Modified Hinchey, AAST, and WSES classifications demonstrate similar performance in predicting complications, reintervention, and mortality.
• AAST and modified Hinchey classifications are most suitable for predicting the need for surgery and major complications in diverticulitis.