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. 2024 Jan;26(1):120-129.
doi: 10.1111/codi.16810. Epub 2023 Nov 27.

Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group

Juan Ocaña  1 , Juan Carlos García-Pérez  1 , Daniel Fernández-Martínez  2 , Ignacio Aguirre  3 , Isabel Pascual  4 , Paola Lora  5 , Eloy Espin-Basany  6 , María Labalde-Martínez  7 , Carmen León  8 , Paula Pastor-Peinado  1 , Carlota López-Domínguez  9 , Nerea Muñoz-Plaza  10 , Ainhoa Valle  11 , Paula Dujovne  12 , David Alías  13 , Leticia Pérez-Santiago  14 , Alba Correa  15 , María Carmona  16 , José María Fernández-Cebrián  1 , Javier Die  1 ; collaborators from The DIPLICAB Study Collaborative Group
Collaborators, Affiliations

Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group

Juan Ocaña et al. Colorectal Dis. 2024 Jan.

Abstract

Aim: Management of diverticulitis with abscess formation in immunosuppressed patients (IMS) remains unclear. The main objective of the study was to assess short- and long-term outcomes between IMS and immunocompetent patients (IC). The secondary aim was to identify risk factors for emergency surgery.

Methods: A nationwide retrospective cohort study was performed at 29 Spanish referral centres between 2015-2019 including consecutive patients with first episode of diverticulitis classified as modified Hinchey Ib or II. IMS included immunosuppressive therapy, biologic therapy, malignant neoplasm with active chemotherapy and chronic steroid therapy. A multivariate analysis was performed to identify independent risk factors to emergency surgery in IMS.

Results: A total of 1395 patients were included; 118 IMS and 1277 IC. There were no significant differences in emergency surgery between IMS and IC (19.5% and 13.5%, p = 0.075) but IMS was associated with higher mortality (15.1% vs. 0.6%, p < 0.001). Similar recurrent episodes were found between IMS and IC (28% vs. 28.2%, p = 0.963). Following multivariate analysis, immunosuppressive treatment, p = 0.002; OR: 3.35 (1.57-7.15), free gas bubbles, p < 0.001; OR: 2.91 (2.01-4.21), Hinchey II, p = 0.002; OR: 1.88 (1.26-2.83), use of morphine, p < 0.001; OR: 3.08 (1.98-4.80), abscess size ≥5 cm, p = 0.001; OR: 1.97 (1.33-2.93) and leucocytosis at third day, p < 0.001; OR: 1.001 (1.001-1.002) were independently associated with emergency surgery in IMS.

Conclusion: Nonoperative management in IMS has been shown to be safe with similar treatment failure than IC. IMS presented higher mortality in emergency surgery and similar rate of recurrent diverticulitis than IC. Identifying risk factors to emergency surgery may anticipate emergency surgery.

Keywords: diverticulitis; immunosuppressed; non-operative management.

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References

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