Surgical Department, Hospital Beatriz Ângelo, Lisbon, Portugal.
Surgical Department, Instituto Português de Oncologia, Lisbon, Portugal.
Tech Coloproctol. 2024 Oct 3;28(1):136. doi: 10.1007/s10151-024-03016-z.
Diverticulitis is experiencing a significant increase in prevalence and its widespread in-hospital management results in a high burden on healthcare systems worldwide. This study compared inpatient and outpatient approach of acute non-complicated diverticulitis using a non-selected population in a real-world setting.
This observational retrospective study included all consecutive patients from two Portuguese institutions diagnosed between January 2017 and December 2021 with non-complicated diverticulitis according to the modified Hinchey Classification. The primary endpoints were to identify criteria for inpatient treatment and compare the outcomes on the basis of the treatment regimen. The secondary endpoints were to determine the predictive factors for clinical outcomes, focusing on treatment failure, pain recurrence, and the need for elective surgery following the initial episode.
A total of 688 patients were included in this study, 437 treated as outpatients and 251 hospitalized. Inpatient management was significantly associated with higher preadmission American society of anesthesiologists (ASA) score (p = 0.004), fever (p = 0.030), leukocytosis (p < 0.001), and elevated C-reactive protein (CRP) (p < 0.001). No significant association was found between failure of conservative treatment and patient's age, ASA score, baseline CRP, presence of systemic inflammatory response syndrome (SIRS), and inpatient or outpatient treatment regimen. Pain recurrence was significantly associated with higher CRP levels (p = 0.049), inpatient treatment regime (p = 0.009) and post index episode mesalazine prescription (p = 0.006). Moreover, the need for elective surgery was significantly associated with the presence of previous episodes (p = 0.004) and pain recurrence (p < 0.001).
The majority of patients with uncomplicated diverticulitis of the left colon experience successful conservative approach and can be safely managed in an ambulatory setting. Neither treatment failure, recurrence of pain, or need for posterior elective surgery are associated with outpatient treatment regimen.
憩室炎的患病率显著增加，其广泛的院内管理导致全球医疗系统负担沉重。本研究在真实环境中比较了非复杂憩室炎的住院和门诊治疗方法，采用了非选择性人群。
这项观察性回顾性研究纳入了 2017 年 1 月至 2021 年 12 月期间，根据改良 Hinchey 分类，在葡萄牙的两家机构诊断为非复杂憩室炎的所有连续患者。主要终点是确定住院治疗的标准，并根据治疗方案比较结果。次要终点是确定临床结局的预测因素，重点是治疗失败、疼痛复发以及首次发作后需要选择性手术。
这项研究共纳入 688 例患者，437 例门诊治疗，251 例住院治疗。住院治疗与较高的入院前美国麻醉医师协会（ASA）评分（p=0.004）、发热（p=0.030）、白细胞增多（p<0.001）和 C 反应蛋白（CRP）升高（p<0.001）显著相关。保守治疗失败与患者年龄、ASA 评分、基线 CRP、全身炎症反应综合征（SIRS）的存在、住院或门诊治疗方案之间无显著相关性。疼痛复发与较高的 CRP 水平（p=0.049）、住院治疗方案（p=0.009）和指数发作后美沙拉嗪处方（p=0.006）显著相关。此外，需要选择性手术与先前发作（p=0.004）和疼痛复发（p<0.001）显著相关。
大多数左结肠非复杂憩室炎患者采用保守治疗方法可获得成功，可安全地在门诊环境中进行管理。无论是治疗失败、疼痛复发还是需要择期手术，都与门诊治疗方案无关。
