Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?

Abstract

PurposeThe aim of this study is to determine the predictable factors that affect the clinical course, especially the hospital stay, the operation performed, and to determine factors that will be helpful in deciding whether in-hospital or outpatient treatment is appropriate.MethodsWe retrospectively collected medical data for patients who had been diagnosed with acute diverticulitis at Inje University Sanggye Paik Hospital between January and December 2016. In total, 117 patients were enrolled in this study. We examined clinical factors, including age, sex, body mass index, pain, body temperature, white blood cell count, C-reactive protein, nil per os (NPO) time, hospital duration, computed tomography (CT) findings, location of diverticulitis, operation performed, and presence of comorbidity (e.g., hypertension and diabetes mellitus).ResultsIn the multivariate analysis, the statistically significant factor related with hospital duration was the presence of perforation on the CT scan (P < 0.001). Longer NPO time was related with pain score (>7) (P = 0.011). Operations were mainly performed in patients with left-sided colonic diverticulitis (P = 0.012).ConclusionWe suggest a perforation finding on the CT scan, a severe pain score at least above 7 on a numeric rating pain scale, and a left-sided lesion are absolute indications for in-hospital management.

Is the outpatient management of acute diverticulitis safe and effective? A systematic review and meta-analysis

“…This review showed that the localization of diverticulitis in the sigmoid colon is not a selection criterion for outpatient management; there is no difference in failure rate between overall (3.79%) versus a selected group with left colon diverticulitis (5.38%). This result disagrees with the results of Yoo et al [32], in which the hospital stay was significantly lower in right diverticulitis (p = < 0.001).…”

“…For the remaining 27 studies, the full texts were obtained and reviewed. Six studies were excluded on the basis of reasons listed in the section of characteristics of excluded studies [20,21,[30][31][32][33]. In total, 21studies fulfilled the inclusion criteria [13-19, 22, 23, 34-45], (Table 1).…”

“…It is not possible to determine if some laboratory markers can be an index for the severity of diverticulitis; no study has reported the evaluation of white blood cell (WBC) or C-reactive protein (CRP) levels. Yoo et al [32] evaluated WBCs and CRP as severity markers, but this analysis does not show any significant prediction of outcome. However, Joung et al reported that a level of CRP ≥ 200 mg/L is associated with a severe clinical course.…”

“…Six studies reported early discharge from hospital and described the possibility of outpatient management in patients with AD [20,21,[30][31][32][33] but the outpatient treatment was not performed [20,21,[30][31][32]. One study performed only an analysis on risk factors for severe outcomes in uncomplicated AD [33].…”

Diverticulitis: An Update From the Age Old Paradigm

“…118 Yoo et al showed no association between the presence of diabetes and need for surgery in their retrospective review of 117 patients with AD. 119 For these reasons comorbidity score is not considered an absolute contra-indication to the out-patient management of uncomplicated AD, but clinical judgement should be used.…”