Our Summary

This research paper looked at the results of emergency surgeries on older patients with acute diverticulitis, a digestive disease. They used data from the American College of Surgeons National Surgical Quality Improvement Project to examine two types of surgeries: the Hartmann procedure and primary anastomosis with diverting loop ileostomy. Patients were grouped by age (<65, 65-79, and 80+ years) and the outcomes of the surgeries were compared.

The study found that patients between the ages of 65-79 and 80+ who had the Hartmann procedure had a higher chance of dying within 30 days of the surgery compared to those under 65. However, patients aged 80+ who had the primary anastomosis with diverting loop ileostomy had lower complications after surgery.

Re-admission rates were similar across all age groups for each procedure. But, when comparing the two surgeries, patients aged 65-79 had lower re-admission rates if they underwent the Hartmann procedure, while those aged 80+ had lower re-admission rates if they had the primary anastomosis with diverting loop ileostomy.

The mortality rate was also lower for patients aged 80+ if they underwent the primary anastomosis with diverting loop ileostomy. For patients aged 65-79, the mortality rate was similar for both surgeries.

The study concluded that the type of surgery chosen for diverticulitis should take into account the patient’s age, as mortality rates and re-admission rates can vary.

FAQs

  1. What were the two types of surgeries examined in this research on diverticulitis?
  2. How did the age of the patient impact the outcomes of the Hartmann procedure and the primary anastomosis with diverting loop ileostomy?
  3. What factors should be considered when choosing the type of surgery for a patient with diverticulitis, according to this study?

Doctor’s Tip

A doctor might tell a patient that the choice of surgery for diverticulitis should take into account their age, as older patients may have different outcomes with different procedures. It’s important to discuss the risks and benefits of each surgery option with your healthcare provider to determine the best course of treatment for you.

Suitable For

In general, patients who are older, particularly those aged 80 and above, may be recommended diverticulitis surgery if they have acute diverticulitis and are at a higher risk of complications. The choice of surgery, whether the Hartmann procedure or primary anastomosis with diverting loop ileostomy, should be carefully considered based on the patient’s age and individual health status to optimize outcomes and reduce the risk of complications.

Timeline

Overall, before diverticulitis surgery, a patient may experience symptoms such as abdominal pain, fever, nausea, and changes in bowel habits. They may undergo imaging tests such as a CT scan to diagnose the condition. Patients may also be treated with antibiotics and a liquid diet before surgery to reduce inflammation and infection.

After surgery, patients will typically stay in the hospital for a few days for monitoring and recovery. They may experience pain, fatigue, and temporary changes in diet and activity level. Follow-up appointments with the surgeon will be needed to monitor healing and address any complications. Over time, patients can gradually resume their normal activities and diet, with the goal of preventing future episodes of diverticulitis.

What to Ask Your Doctor

Some questions a patient should ask their doctor about diverticulitis surgery include:

  1. What are the risks and benefits of each type of surgery (Hartmann procedure vs. primary anastomosis with diverting loop ileostomy) for diverticulitis in older patients?
  2. How does my age impact the outcomes of the surgery, including mortality rates and re-admission rates?
  3. Are there any alternative treatment options to surgery for diverticulitis that I should consider?
  4. What is the recovery process like for each type of surgery, and how long can I expect to be in the hospital?
  5. What are the potential long-term effects of each type of surgery on my digestive health and overall well-being?
  6. How experienced are you in performing these types of surgeries, and what is your success rate with older patients?
  7. Are there any specific pre-operative or post-operative care instructions I should follow to ensure the best possible outcome?
  8. Will I need any additional follow-up appointments or monitoring after the surgery?
  9. How can I best prepare myself physically and mentally for the surgery and recovery process?
  10. Are there any specific dietary or lifestyle changes I should make after the surgery to prevent future episodes of diverticulitis?

Reference

Authors: Quinn S, Akram W, Hao S, Honaker MD. Journal: J Am Med Dir Assoc. 2022 Apr;23(4):616-622.e1. doi: 10.1016/j.jamda.2022.02.001. Epub 2022 Mar 1. PMID: 35245484