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Hospitalization for Acute Diverticulitis Does Not Mandate Routine Elective Colectomy
Gregory Broderick-Villa, MD;
Raoul J. Burchette, MA, MS;
J. Craig Collins, MD;
Maher A. Abbas, MD;
Philip I. Haigh, MD, MSc, FRCSC
Arch Surg. 2005;140:576-583.
Background Previous studies suggest that elective colectomy is often required after an episode of acute diverticulitis.
Hypothesis Acute diverticulitis initially treated nonoperatively does not require elective colectomy.
Design Retrospective cohort study.
Setting Twelve Kaiser Permanente hospitals in Southern California.
Patients Three thousand one hundred sixty-five patients with acute diverticulitis.
Interventions Colectomy or nonoperative treatment with or without percutaneous abscess drainage.
Main Outcome Measures Recurrent diverticulitis.
Results Emergency colectomy was performed in 614 patients (19.4%). Nonoperative treatment was initially used in 2551 patients (80.6%). Of these, 185 patients (7.3%) had an elective colectomy and the remaining 2366 patients (92.7%) did not. Factors associated with undergoing elective colectomy compared with nonoperative treatment were younger age of the patient, fewer comorbidities, and percutaneous abscess drainage. Mean follow-up was 8.9 years, with a maximum of 12 years. After nonoperative treatment, 314 patients (13.3%) recurred—222 patients had a single recurrence and 92 patients had a rerecurrence. After adjusting for other variables, older age (hazard ratio,  50 years vs <50 years = 0.68; 95% confidence interval, 0.53-0.87) was associated with a lower recurrence, whereas higher comorbidity was associated with higher recurrence. Gender and percutaneous abscess drainage had no influence on recurrence. All 92 rerecurrences were treated nonoperatively. The risk of a rerecurrence (29.3%) was significantly higher than a first recurrence (P<.001). Age, gender, Charlson comorbidity index, and percutaneous abscess drainage did not predict rerecurrence.
Conclusions Very few patients with acute diverticulitis treated nonoperatively have recurrence. Younger age was associated with recurrence. A first recurrence was the only factor that predicted rerecurrences. The low recurrence rate argues against routine elective colectomy after successful nonoperative management of acute diverticulitis.
Author Affiliations: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, Calif (Drs Broderick-Villa, Collins, Abbas, and Haigh); and the Center for Research and Evaluation, Kaiser Permanente Regional Offices, Pasadena, Calif (Mr Burchette).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
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NEJM 2007;357:2057-2066.
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