التفاصيل البيبلوغرافية
| العنوان: |
Post-operative morbidity, but not mortality, is worsened by operative delay in septic diverticulitis. |
| المؤلفون: |
Mozer, Anthony1, Spaniolas, Konstantinos1, Sippey, Megan1, Celio, Adam1, Manwaring, Mark1, Kasten, Kevin1 kastenk14@ecu.edu |
| المصدر: |
International Journal of Colorectal Disease. Feb2017, Vol. 32 Issue 2, p193-199. 7p. 3 Charts. |
| مصطلحات موضوعية: |
*DIVERTICULOSIS, *DISEASES, *SURGICAL complications, *DEMOGRAPHY |
| الشركة/الكيان: |
AMERICAN College of Surgeons |
| مستخلص: |
Purpose: Optimal timing of surgery for acute diverticulitis remains unclear. A non-operative approach followed by elective surgery 6-week post-resolution is favored. However, a subset of patients fail on the non-operative management during index admission. Here, we examine patients requiring emergent operation to evaluate the effect of surgical delay on patient outcomes. Methods: Patients undergoing emergent operative intervention for acute diverticulitis were queried using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2012. Primary endpoints of 30-day overall morbidity and mortality were evaluated via univariate and multivariate analysis. Results: Of the 2,119 patients identified for study inclusion, 57.2 % ( n = 1212) underwent emergent operative intervention within 24 h, 26.3 % ( n = 558) between days 1-3, 12.9 % ( n = 273) between days 3-7, and 3.6 % ( n = 76) greater than 7 days from admission. End colostomy was performed in 77.4 % ( n = 1,640) of cases. Unadjusted age and presence of major comorbidities increased with operative delay. Further, unadjusted 30-day overall morbidity, mortality, septic complications, and post-operative length of stay increased significantly with operative delay. On multivariate analysis, operative delay was not associated with increased 30-day mortality but was associated with increased 30-day overall morbidity. Conclusions: Hartmann's procedure has remained the standard operation in emergent surgical management of acute diverticulitis. Delay in definitive surgical therapy greater than 24 h from admission is associated with higher rates of morbidity and protracted post-operative length of stay, but there is no increase in 30-day mortality. Prospective study is necessary to further answer the question of surgical timing in acute diverticulitis. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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