Patients with diverticulitis are at a lifetime risk for emergency colectomy and colostomy.
Age and recurrence characteristics can serve to predict the risk for these adverse outcomes.
Dr Daniel Anaya and Dr David Flum from Seattle used time-to-event analysis and logistic regression to determine the risk of emergency colectomy/colostomy.
The research team conducted a retrospective cohort study using a statewide administrative database and identifying all patients hospitalized nonelectively for diverticulitis from 1987 to 2001.
|Patients less than 50 years were 27% more likely to have a recurrence vs older patients|
|Archives of Surgery|
The team's main outcome measure was emergency colectomy and/or colostomy in patients treated nonsurgically after a first episode of acute diverticulitis.
The researchers identified a total of 25,058 patients with a mean age of 69 years, of which 60% were female, and who were hospitalized for an initial episode of diverticulitis.
Of the 20,136 patients treated without initial operation, the team found that 19% had recurrences, with patients less than 50 years were 27% more likely to have a recurrence than older patients.
The researchers noted that 6% of patients had recurrent hospitalizations during which an emergency colectomy/colostomy was performed.
However, the team observed that recurrent hospitalizations occurred more commonly in younger patients.
The researchers found that the adjusted hazard ratio for emergency colectomy/colostomy in younger patients was 39% higher than in older patients.
Among all patients, the adjusted hazard ratio for emergency colectomy/colostomy was 2 times higher with each subsequent admission .
The researchers also observed that the predicted probability of emergency colectomy/colostomy was highest in younger patients with multiple rehospitalizations.
Dr Anaya and colleague concluded, “Age and number of recurrent events were associated with the risk of emergency colectomy/colostomy after successful nonoperative management in patients with diverticulitis.”
“Individualization of recommendations regarding elective colectomy based on these factors may be more appropriate than the application of previously published strategies.”