title: Emergency surgery for acute diverticulitis: which operation? A National Surgical Quality Improvement Program study.
abstract: BACKGROUND
  The optimal surgical management of acute diverticulitis is still a controversial and unresolved issue. While the Hartmann's procedure (`) is the most commonly performed operation, primary anastomosis (PA), with or without proximal diversion, has also been used with increasing frequency.
  
  
  METHODS
  This is a National Surgical Quality Improvement Program database study including all patients requiring emergency surgery for acute diverticulitis. Three operative approaches were analyzed: HP, colectomy with PA, and colectomy with PA with proximal diversion (PAPD). Mortality and postoperative outcomes were compared between the three groups using a logistical regression model.
  
  
  RESULTS
  There were 1,314 patients who required emergent operation for acute diverticulitis, 75.4% underwent HP, 21.7% underwent PA, and 2.9% underwent PAPD. Thirty-day mortality was 7.3%, 4.6%, and 1.6% for HP, PA, and PAPD respectively (p = 0.163), while surgical site infections occurred in 19.7%, 17.9%, and 13.2%, respectively (p = 0.59). After multivariable analysis adjusting for age, alcohol consumption, comorbidities, steroid use, preoperative laboratory values, hemorrhage at admission and laparoscopic surgery, the adjusted odds ratio for 30-day mortality comparing PA with HP was 0.77 (95% confidence interval [CI], 0.38-1.56; p = 0.465), 0.47 (95% CI, 0.06-3.74; p = 0.479) comparing PAPD with HP, and 1.62 (95% CI, 0.19-13.78; p = 0.658) comparing PA with PAPD. In addition, the three groups did not have significantly different adjusted odds ratio for the development of surgical infectious complications, acute kidney injury, cardiovascular incidents, or venous thromboembolism after surgery.
  
  
  CONCLUSIONS
  Resection and PA in patients undergoing an emergency operation for acute diverticulitis is a safe alternative to the HP, with no significant difference in mortality or postoperative surgical site infections.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: Department of Surgery, University of Southern California, Los Angeles, California 90033, USA.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Tadlock
authors.forename: Efstathios
authors.initials: E
authors.lastname: Karamanos
authors.forename: Dimitra
authors.initials: D
authors.lastname: Skiada
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Anthony
authors.initials: A
authors.lastname: Senagore
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000208:Acute Disease; D000714:Anastomosis, Surgical / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D003106:Colon / Q000601:surgery; D003125:Colostomy / Q000401:mortality / Q000706:statistics & numerical data; D016208:Databases, Factual; D004239:Diverticulitis, Colonic / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D058996:Quality Improvement