Predictive factors for conservative treatment failure of acute complicated diverticulitis: a single-center...

According to WSES guidelines conservative/non-operative treatment is the first-line therapy for acute complicated diverticulitis (ACD) but failure may represent a challenge in terms of hospitalization, medical costs, morbidities, and mortality. This study aimed to evaluate failure rates following non-operative management of acute complicated diverticulitis and to examine possible predictive factors for failure. We retrospectively analyzed all patients with a diagnosis of diverticulitis consecutively admitted to our Institution from 1 January 2017 to 31 December 2021. Patient demographics, blood inflammatory markers, radiological findings, management, and outcomes were evaluated.A total of 164 patients were included, 34 had uncomplicated diverticulitis and 130 had ACD. Among those with ACD, 18 patients underwent urgent surgery and 112 (WSES 1a n = 54, 1b n = 19, 2a n = 31, 2b n = 8) underwent conservative/nonoperative treatment, consisted of intravenous antibiotics with or without percutaneous drainage. Twenty-three patients (20.5%) failed conservative treatment. Univariate analysis revealed that male sex, obesity (BMI>30), low performance status (ASA > 2), and intra-abdominal abscess greater than 4 cm on CT scan, were significantly associated with conservative treatment failure. Multivariate analysis proved that obesity[OR 2.92; 95%CI 1.104-7.702; p-value 0.046] and intra-abdominal abscess > 4 cm [OR 3.66; 95%CI 1.386-9.672; p-value 0.014], were possible predictive factors of conservative treatment failure.Conservative/non-operative treatment of acute complicated.