Al-Saadi Hassan, Abdulrasool Haider, Murphy Elizabeth
General Surgery Unit, Western Health, Melbourne, AUS.
General Surgery Unit, Lyell McEwin Hospital, Adelaide, AUS.
Cureus. 2023 Feb 1;15(2):e34482. doi: 10.7759/cureus.34482. eCollection 2023 Feb.
Acute diverticulitis represents a common surgical condition and one of the leading gastrointestinal causes of hospital admissions in Western societies. The aim of the study is to examine the distribution, management and cost to healthcare of complicated diverticulitis and compare those to uncomplicated diverticulitis.
The case-control study was performed for patients with acute diverticulitis in Lyell McEwin Hospital in Adelaide, South Australia. Data were collected for patients presented from January 2015 to December 2017. Consecutive patients with acute diverticulitis confirmed by computed tomography were included in the study. Patients recruited for the study were divided into two groups. Patients presenting with Hinchey Ia diverticulitis were classified as 'uncomplicated diverticulitis'. Patients who presented with Hinchey Ib, II, III or IV diverticulitis were classified as 'complicated diverticulitis'. The Hinchey classification was based on the radiological reports of CT scans.
From 2015-2017, 116 cases were screened for the study, 10 of which were excluded due to not having CT diagnosis. A total of 106 consecutive cases of acute diverticulitis were recruited for the study. Forty-four cases had complicated diverticulitis. Sixty-two cases with uncomplicated diverticulitis were allocated as a control group. The distribution of cases spanned through all age groups. There were nine cases (20.9%) in the 30-39 age group in the complicated diverticulitis compared to eight cases (12.9%) in the uncomplicated group with odds ratio 1.7 (0.61-4.92). The mean length of stay of the complicated diverticulitis group was 7.74 days compared to 3.93 days of the uncomplicated group with a p value of 0.000235. Nine (20%) cases of the 44 complicated diverticulitis cases were managed operatively, while 35 (80%) of the complicated diverticulitis group and all of the uncomplicated (control) group were managed conservatively. Localized perforations were 24 cases (54.5%) of the complicated diverticulitis group and collections were 18 cases (40.8%). Those cases collectively represented the majority of the complicated group.
Complicated diverticulitis increases the length of stay significantly in acute diverticulitis cases that are requiring hospital admission despite conservative management in 80% of the cases. Younger age groups represent a significant percentage of both complicated and uncomplicated diverticulitis. In the study population, the percentage of the younger age group was higher in complicated diverticulitis compared to uncomplicated diverticulitis, although this increased risk did not reach statistical significance. This will need to be further investigated in future studies.
急性憩室炎是一种常见的外科疾病，也是西方社会导致住院的主要胃肠道病因之一。本研究的目的是检查复杂性憩室炎的分布、管理及医疗成本，并将其与非复杂性憩室炎进行比较。
在南澳大利亚阿德莱德的莱尔·麦克尤恩医院对急性憩室炎患者进行病例对照研究。收集2015年1月至2017年12月就诊患者的数据。经计算机断层扫描确诊的急性憩室炎连续患者纳入研究。研究招募的患者分为两组。表现为欣奇伊Ia型憩室炎的患者被归类为“非复杂性憩室炎”。表现为欣奇伊Ib、II、III或IV型憩室炎的患者被归类为“复杂性憩室炎”。欣奇伊分类基于CT扫描的放射学报告。
2015 - 2017年，共筛查116例患者用于本研究，其中10例因未进行CT诊断而被排除。共招募106例急性憩室炎连续病例用于研究。44例为复杂性憩室炎。62例非复杂性憩室炎患者被分配为对照组。病例分布涵盖所有年龄组。复杂性憩室炎组30 - 39岁年龄组有9例（20.9%），非复杂性组有8例（12.9%），优势比为1.7（0.61 - 4.92）。复杂性憩室炎组的平均住院时间为7.74天，非复杂性组为3.93天，p值为0.000235。44例复杂性憩室炎病例中有9例（20%）接受了手术治疗，而复杂性憩室炎组的35例（80%）和所有非复杂性（对照）组均接受保守治疗。局限性穿孔在复杂性憩室炎组中占24例（54.5%），积液占18例（40.8%）。这些病例共同构成了复杂性组的大部分。
尽管80%的病例采用保守治疗，但复杂性憩室炎显著增加了急性憩室炎患者的住院时间，这些患者需要住院治疗。较年轻年龄组在复杂性和非复杂性憩室炎中均占相当比例。在研究人群中，复杂性憩室炎中较年轻年龄组的百分比高于非复杂性憩室炎，尽管这种增加的风险未达到统计学意义。这需要在未来的研究中进一步调查。
