Post-operative morbidity, but not mortality, is worsened by operative delay in septic diverticulitis

Mozer, Anthony B.; Spaniolas, Konstantinos; Sippey, Megan; Celio, Adam C.; Manwaring, Mark L.; Kasten, Kevin R.

doi:10.1007/s00384-016-2689-0

Cited by 19 publications

(17 citation statements)

References 33 publications

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“…The rate of IHDs of 36·8 per cent in the present study was similar to that in an earlier study at a well staffed teaching hospital in Nigeria, where 50 per cent of patients waited over 24 h, and 16 per cent waited more than 48 h for operative intervention. At a regional hospital in Uganda 48 per cent of 31 operations were delayed (median delay 14·8 h), and in the Ivory Coast 86 per cent of patients had a delay of more than 24 h from symptom onset to surgery, with more than 36 per cent waiting over 48 h. Delays were defined in the present study as longer than 24 h. Most surgeons would agree that this is too long to wait for emergency care, and several other studies, especially in LMICs, have used this definition, although some high‐income countries (HICs) have used shorter times. Future research to measure specific time intervals, including time to decision to operate, time to diagnostic studies and exact times to procedures, should clarify the length of an acceptable in‐hospital wait.…”

Section: Discussionmentioning

confidence: 85%

“…In HICs, delays are often considered to have shorter intervals of less than 6 or 12 h 7,8,22 . Even these shorter delays are associated with increased mortality for emergency abdominal surgery 7,8,12 , as well as specific conditions including perforated diverticulitis 11 and peptic ulcer disease 9 . In two Danish cohort studies 9,12 , each hour of operative delay was associated with a 2 per cent reduction in survival.…”

Section: Resultsmentioning

confidence: 99%

“…Delays in surgical intervention for emergency conditions increase mortality. The three primary sources of delay to surgical care for patients in limited‐resource settings include: delay in seeking care (pre‐hospital), delay in transferring to a facility equipped to perform the procedure (interfacility), and delay from presentation at a hospital able to provide definitive care to the start of the operative intervention (in‐hospital delays; IHDs).…”

Section: Introductionmentioning

confidence: 99%

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Effect of in‐hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi

et al. 2019

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Background In sub‐Saharan Africa, surgical access is limited by an inadequate surgical workforce, lack of infrastructure and decreased care‐seeking by patients. Delays in treatment can result from delayed presentation (pre‐hospital), delays in transfer (intrafacility) or after arrival at the treating centre (in‐hospital delay; IHD). This study evaluated the effect of IHD on mortality among patients undergoing emergency general surgery and identified factors associated with IHD. Methods Utilizing Malawi's Kamuzu Central Hospital Emergency General Surgery database, data were collected prospectively from September 2013 to November 2017. Included patients had a diagnosis considered to warrant urgent or emergency intervention for surgery. Bivariable analysis and Poisson regression modelling was done to determine the effect of IHD (more than 24 h) on mortality, and identify factors associated with IHD. Results Of 764 included patients, 281 (36·8 per cent) had IHDs. After adjustment, IHD (relative risk (RR) 1·68, 95 per cent c.i. 1·01 to 2·78; P = 0·045), generalized peritonitis (RR 4·49, 1·69 to 11·95; P = 0·005) and gastrointestinal perforation (RR 3·73, 1·25 to 11·08; P = 0·018) were associated with a higher risk of mortality. Female sex (RR 1·33, 1·08 to 1·64; P = 0·007), obtaining any laboratory results (RR 1·58, 1·29 to 1·94; P < 0·001) and night‐time admission (RR 1·59, 1·32 to 1·90; P < 0·001) were associated with an increased risk of IHD after adjustment. Conclusion IHDs were associated with increased mortality. Increased staffing levels and operating room availability at tertiary hospitals, especially at night, are needed.

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Section: Discussionmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of in‐hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi

et al. 2019

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“…al performed a retrospective ACS-NSQIP similar to our study focusing on strictly emergent cases of AD as defined by clinical deterioration related to sepsis (17). Operative delay beyond 24 hours was associated with an increase in morbidity but not mortality.…”

Section: Discussionmentioning

confidence: 95%

“…The multiple variable logistic regression analysis estimated odds ratios and 95% confidence intervals for days from admission for each outcome adjusted for confounders. The solution to the regression equation was used to predict the average probability of each outcome for each day following admission (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Average predicted values for each day were plotted to show the trend over 1 -20 days.…”

Section: Discussionmentioning

confidence: 99%

Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

et al. 2017

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Background: Ideal operative timing for non-emergent, acute diverticulitis (AD) remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy. Objectives: To evaluate the effect of operative delay on sepsis and mortality in patients with AD. Methods: Patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI), pneumonia (PNA), need for blood transfusion, septic shock, return to the operating room, length of stay (LOS), readmission, wound dehiscence, and surgical site infections (SSI). Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for primary and secondary outcomes. Results: 32,399 patients underwent colectomy for AD on hospital day 1 -20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 -1.057; P < 0.0001) and sepsis (OR = 1.051, 95% CI, 1.035 -1.067; P < 0.0001). Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion, return to the operating room and increased LOS. Conclusions: Delaying operation for patients with AD has a significant impact on sepsis and mortality. While non-operative approaches may be attempted, with each additional day operative therapy is delayed there is a significant increase in the risk of morbidity and mortality. This data suggests that surgeons should pursue operative therapy earlier in the hospital course to improve patient outcomes.

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German guideline diverticular disease/diverticulitis

et al. 2022

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Diverticulosis and diverticular disease are ranked among the most common gastroenterological diseases and conditions. While for many years diverticulitis was found to be mainly an event occurring in the elder population, more recent work in epidemiology demonstrates increasing frequency in younger subjects. In addition, there is a noticeable trend towards more complicated disease. This may explain the significant increase in hospitalisations observed in recent years. It is not a surprise that the number of scientific studies addressing the clinical and socioeconomic consequences in the field is increasing. As a result, diagnosis and conservative as well as surgical management have changed in recent years. Diverticulosis, diverticular disease and diverticulitis are a complex entity and apparently anThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Post-operative morbidity, but not mortality, is worsened by operative delay in septic diverticulitis

Cited by 19 publications

References 33 publications

Effect of in‐hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi

Effect of in‐hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi

Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

German guideline diverticular disease/diverticulitis

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