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Risk factors for recurrence and complications in acute uncomplicated diverticulitis : A retrospective cohort study

Sahli, Hannah ; Azhar, Najia LU orcid ; Lydrup, Marie Louise LU ; Jörgren, Fredrik LU ; Schultz, Johannes LU and Buchwald, Pamela LU (2022) In International Journal of Surgery Open 43.
Abstract

Introduction: Antibiotics for acute uncomplicated diverticulitis (AUD) have been questioned in several studies. Thus, it is of value to identify risk factors for recurrence and complications to identify the best strategy for treatment. The aim was to investigate risk factors for recurrence and complications within at least 1 year after hospitalization for AUD. Methods: This is a retrospective study, including patients hospitalized with AUD at Helsingborg Hospital and Skåne University Hospital in Sweden during January 1st, 2015–December 31st, 2017. The cohort was primarily collected via the in-patient registry. Patients with multiple registrations, acute complicated diverticulitis, ongoing antibiotics, other diagnoses, immunosuppression... (More)

Introduction: Antibiotics for acute uncomplicated diverticulitis (AUD) have been questioned in several studies. Thus, it is of value to identify risk factors for recurrence and complications to identify the best strategy for treatment. The aim was to investigate risk factors for recurrence and complications within at least 1 year after hospitalization for AUD. Methods: This is a retrospective study, including patients hospitalized with AUD at Helsingborg Hospital and Skåne University Hospital in Sweden during January 1st, 2015–December 31st, 2017. The cohort was primarily collected via the in-patient registry. Patients with multiple registrations, acute complicated diverticulitis, ongoing antibiotics, other diagnoses, immunosuppression and non-CT-verified diagnosis were excluded. Follow-up was ≥1 year. SPSS was used for statistical analysis. Results: Out of 596 patients, 23% experienced recurrences and 3% experienced complications. Previous diverticulitis [OR 2.86 (CI 1.85–4.55) P < 0.001] and complications [OR 1.35 (CI 1.18–1.42) P < 0.001] were independent risk factors for recurrence. A higher Charlson morbidity index (CMI) [OR 1.27 (1.0–1.61) P = 0.04] and previous diverticulitis [OR 3.68 (1.24–10.9) P = 0.013] were associated with complications. 75% of the patients received antibiotics but this did not significantly improve outcomes. Conclusion: A history of previous diverticulitis or complications increases the risk for AUD recurrence. A higher CMI and a history of previous diverticulitis may be risk factors for complications but needs to be further assessed. Treatment with antibiotics does not appear to improve the outcome. Choice of treatment should therefore be individualized and based on risk factors for complications and recurrence.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute uncomplicated diverticulitis, Antibiotics, Complications, Recurrence, Risk factors
in
International Journal of Surgery Open
volume
43
article number
100471
publisher
Elsevier
external identifiers
  • scopus:85130372135
ISSN
2405-8572
DOI
10.1016/j.ijso.2022.100471
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2022 The Author(s)
id
3673b34e-b52a-48a9-a336-7b7acaa3160a
date added to LUP
2022-08-31 14:24:54
date last changed
2023-05-15 11:25:00
@article{3673b34e-b52a-48a9-a336-7b7acaa3160a,
  abstract     = {{<p>Introduction: Antibiotics for acute uncomplicated diverticulitis (AUD) have been questioned in several studies. Thus, it is of value to identify risk factors for recurrence and complications to identify the best strategy for treatment. The aim was to investigate risk factors for recurrence and complications within at least 1 year after hospitalization for AUD. Methods: This is a retrospective study, including patients hospitalized with AUD at Helsingborg Hospital and Skåne University Hospital in Sweden during January 1st, 2015–December 31st, 2017. The cohort was primarily collected via the in-patient registry. Patients with multiple registrations, acute complicated diverticulitis, ongoing antibiotics, other diagnoses, immunosuppression and non-CT-verified diagnosis were excluded. Follow-up was ≥1 year. SPSS was used for statistical analysis. Results: Out of 596 patients, 23% experienced recurrences and 3% experienced complications. Previous diverticulitis [OR 2.86 (CI 1.85–4.55) P &lt; 0.001] and complications [OR 1.35 (CI 1.18–1.42) P &lt; 0.001] were independent risk factors for recurrence. A higher Charlson morbidity index (CMI) [OR 1.27 (1.0–1.61) P = 0.04] and previous diverticulitis [OR 3.68 (1.24–10.9) P = 0.013] were associated with complications. 75% of the patients received antibiotics but this did not significantly improve outcomes. Conclusion: A history of previous diverticulitis or complications increases the risk for AUD recurrence. A higher CMI and a history of previous diverticulitis may be risk factors for complications but needs to be further assessed. Treatment with antibiotics does not appear to improve the outcome. Choice of treatment should therefore be individualized and based on risk factors for complications and recurrence.</p>}},
  author       = {{Sahli, Hannah and Azhar, Najia and Lydrup, Marie Louise and Jörgren, Fredrik and Schultz, Johannes and Buchwald, Pamela}},
  issn         = {{2405-8572}},
  keywords     = {{Acute uncomplicated diverticulitis; Antibiotics; Complications; Recurrence; Risk factors}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Surgery Open}},
  title        = {{Risk factors for recurrence and complications in acute uncomplicated diverticulitis : A retrospective cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.ijso.2022.100471}},
  doi          = {{10.1016/j.ijso.2022.100471}},
  volume       = {{43}},
  year         = {{2022}},
}