Population-based study of outcomes following an initial acute diverticular abscess

Abstract

Background: Studies examining long-term outcomes following resolution of an acute diverticular abscess have been limited to single-institution chart reviews. This observational cohort study compared outcomes between elective colectomy and non-operative management following admission for an initial acute diverticular abscess. Methods: The Statewide Planning and Research Cooperative System was queried for unscheduled admissions for an initial acute diverticular abscess in 2002-2010. Bivariable and propensity-matched multivariable analyses compared stoma rates and use of healthcare in patients who had an elective resection and those receiving non-operative management. Diverticulitis recurrence rates were analysed for non-operative management.Results: Among 10 342 patients with an initial acute diverticular abscess, one-third (3270) underwent surgical intervention within 30 days despite initial non-operative management. Of the remaining 7072 patients, 1660 had an elective colectomy within 6 months. Of 5412 patients receiving non-operative management, 1340 (24⋅8 per cent) had recurrence of diverticulitis within 5 years (median 278 (i.q.r. 93⋅5-707) days to recurrence). Elective colectomy was associated with higher stoma rates (10⋅0 per cent, compared with 5⋅7 per cent for non-operative observation, P < 0⋅001; odds ratio 1⋅88, 95 per cent c.i. 1⋅50 to 2⋅36), as well as more inpatient hospital days for diverticulitis-related admissions (mean 8⋅0 versus 4⋅6 days respectively, P < 0⋅001; incidence rate ratio (IRR) 2⋅16, 95 per cent c.i. 1⋅89 to 2⋅47) and higher mean diverticulitis-related cost (€70 107 versus €24 490, P < 0⋅001; IRR 3⋅11, 2⋅42 to 4⋅01).Conclusion: Observation without elective colectomy following resolution of an initial diverticular abscess is a reasonable option with lower healthcare costs than operation.

Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial

“…The role of percutaneous drainage for diverticulitis with abscess formation has been debated 36,37 . Subsequently, follow-up without elective colectomy after non-operative treatment of an initial episode of diverticulitis with abscess formation or local extraluminal air seems justified 38,39 . Moreover, evidence shows that HP for perforated diverticulitis should be avoided if possible and that PA is preferred [9][10][11] .…”

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

“…A systematic review shows a recurrence rate of 25.5% in 7653 patients with diverticular abscesses [109]. Other studies that are published later show mostly comparable rates of 25%-30% but ranging from 9% to 61% [50,110,[158][159][160][161][162]. Several studies included in the systematic review do not show an increased risk for complications in recurrent episodes; others [160] report a 63% complicated recurrence rate and the previously discussed large observational study [110] shows 43% of recurrences being complicated.…”

AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review

“…In a large retrospective cohort study, the risk of diverticulitis recurrence was 25% within 5 years after an episode with an abscess successfully managed without surgery. 48 Best Practice Advice 13: An elective segmental resection should not be advised based on the number of diverticulitis episodes.…”