Our Summary

This research looked at the characteristics of patients with diverticulitis (an inflammation or infection in one or more small pouches in the digestive tract) before they had surgery. The goal was to find out which characteristics might indicate a need for emergency surgery, and to compare the outcomes for patients who had emergency surgery with those who had planned, or elective, surgery.

The researchers found that patients who needed emergency surgery were more likely to have used steroids, have diabetes, cancer that had spread, kidney failure, high blood pressure, heart failure, liver disease, chronic obstructive pulmonary disease (a type of lung disease), and be dependent on others for their daily needs. They were also more likely to be over 65, have a history of smoking, and have a body mass index (a measure of body fat based on height and weight) under 18.5, which is considered underweight.

After taking into account all the factors, the research found that using steroids, losing more than 10% of body weight, having a body mass index under 18, smoking, being over 65, and having other health conditions were all linked to a higher chance of needing emergency surgery.

The study also found that patients who had emergency surgery had higher rates of death (5.2% compared to 0.2% for elective surgery), and more complications, both infectious and non-infectious. They also stayed in the hospital longer and were more likely to need another operation.

In conclusion, emergency surgery for diverticulitis has worse outcomes than planned surgery. Therefore, patients with other health problems who have attacks of diverticulitis might benefit from planned surgery earlier, rather than waiting for an emergency situation.

FAQs

  1. What preoperative characteristics were found to possibly determine the need for emergency surgery for diverticulitis?
  2. How do the postoperative outcomes for patients who underwent emergency surgery for diverticulitis compare with those who had elective surgery?
  3. What factors were associated with a higher rate of emergent/urgent surgery for diverticulitis in the study?

Doctor’s Tip

A helpful tip a doctor might give a patient about diverticulitis surgery is to maintain a healthy lifestyle and manage any comorbid conditions to reduce the risk of needing emergency surgery in the future. This may include controlling diabetes, hypertension, and other chronic conditions, as well as maintaining a healthy weight and avoiding smoking. Additionally, it is important for patients to follow their doctor’s recommendations for postoperative care and attend follow-up appointments to monitor their recovery and prevent complications.

Suitable For

Patients who are typically recommended diverticulitis surgery are those who have preoperative characteristics such as preoperative steroid use, weight loss >10 per cent, BMI < 18 kg/m², smoking history, age > 65 years, and comorbid conditions such as diabetes mellitus, disseminated cancer, chronic renal failure, hypertension, chronic heart failure, chronic liver disease, COPD, and dependent functional health status. These patients may be at higher risk for needing emergent or urgent surgery for diverticulitis.

It is important to note that emergency and urgent colectomy for diverticulitis is associated with significantly worse outcomes compared to elective surgery, including higher mortality, infectious and noninfectious complications, longer hospital stay, and higher rates of reoperation. Therefore, patients with comorbid conditions who develop attacks of diverticulitis may benefit from a lower threshold for elective colectomy to prevent the need for emergent or urgent surgery.

Timeline

Before diverticulitis surgery:

  • Patient may experience symptoms such as abdominal pain, bloating, constipation, and diarrhea
  • Patient may undergo diagnostic tests such as a CT scan or colonoscopy to confirm the diagnosis
  • Patient may be treated with antibiotics and a liquid diet to manage the acute attack

After diverticulitis surgery:

  • Patient will undergo preoperative evaluations and tests to assess their overall health and readiness for surgery
  • Patient will be informed about the risks and benefits of surgery and may meet with a surgeon to discuss the procedure
  • Patient will undergo the surgery, which may be either elective or emergent/urgent depending on the severity of the condition
  • After surgery, patient may experience pain, bloating, and changes in bowel habits as they recover
  • Patient will be monitored closely for any complications such as infection or bowel perforation
  • Patient will be instructed on postoperative care, including diet restrictions and activity limitations
  • Patient will have follow-up appointments with their surgeon to monitor their recovery and address any concerns

What to Ask Your Doctor

  1. What are the potential risks and complications associated with diverticulitis surgery?
  2. How long is the recovery period after surgery?
  3. What is the success rate of diverticulitis surgery in relieving symptoms?
  4. Are there any alternative treatment options to surgery that I should consider?
  5. How often do patients need to undergo additional surgeries after diverticulitis surgery?
  6. Will I need to make any changes to my diet or lifestyle after surgery?
  7. How long will I need to stay in the hospital after surgery?
  8. What is the long-term outlook for someone who has undergone diverticulitis surgery?
  9. Are there any specific postoperative care instructions or medications that I should be aware of?
  10. How can I best prepare for diverticulitis surgery to ensure the best possible outcome?

Reference

Authors: Valizadeh N, Suradkar K, Kiran RP. Journal: Am Surg. 2018 Nov 1;84(11):1781-1786. PMID: 30747633