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01-09-2017 | Original Scientific Report

Uncomplicated Acute Diverticulitis: Identifying Risk Factors for Severe Outcomes

Authors: Rebekah Jaung, Malsha Kularatna, Jason P. Robertson, Ryash Vather, David Rowbotham, Andrew D. MacCormick, Ian P. Bissett

Published in: World Journal of Surgery | Issue 9/2017

Abstract

Background

The management of uncomplicated (Modified Hinchey Classification Ia) acute diverticulitis (AD) has become increasingly conservative, with a focus on symptomatic relief and supportive management. Clear criteria for patient selection are required to implement this safely. This retrospective study aimed to identify risk factors for severe clinical course in patients with uncomplicated AD.

Materials and methods

Patients admitted to General Surgery at two New Zealand tertiary centres over a period of 18 months were included. Univariate and multivariate analyses were carried out in order to identify factors associated with a more severe clinical course. This was defined by three endpoints: need for procedural intervention, admission >7 days and 30-day readmission; these were analysed separately and as a combined outcome.

Results

Uncomplicated AD was identified in 319 patients. Fifteen patients (5%) required procedural intervention; this was associated with SIRS (OR 3.92). Twenty-two (6.9%) patients were admitted for >7 days; this was associated with patient-reported pain score >8/10 (OR 5.67). Thirty-one patients (9.8%) required readmission within 30 days; this was associated with pain score >8/10 (OR 6.08) and first episode of AD (OR 2.47). Overall, 49 patients had a severe clinical course, and associated factors were regular steroid/immunomodulator use (OR 4.34), pain score >8/10 (OR 5.9) and higher temperature (OR 1.51) and CRP ≥200 (OR 4.1).

Conclusion

SIRS, high pain score and CRP, first episode and regular steroid/immunomodulator use were identified as predictors of worse outcome in uncomplicated AD. These findings have the potential to inform prospective treatment decisions in this patient group.

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Title: Uncomplicated Acute Diverticulitis: Identifying Risk Factors for Severe Outcomes
Authors: Rebekah Jaung
Malsha Kularatna
Jason P. Robertson
Ryash Vather
David Rowbotham
Andrew D. MacCormick
Ian P. Bissett
Publication date: 01-09-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 9/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4012-9

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Springer Medicine

Uncomplicated Acute Diverticulitis: Identifying Risk Factors for Severe Outcomes

Abstract

Background

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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