title: Surgeon, not disease severity, often determines the operation for acute complicated diverticulitis.
abstract: BACKGROUND
  The "best" operation in the setting of acute complicated diverticulitis has been debated for decades. Multiple studies, including a recent prospective randomized trial, have reported improved outcomes with primary anastomosis. The aim of this study was to determine whether surgeon or patient-specific factors drives the choice of operative procedure.
  
  
  METHODS
  Consecutive adult patients with sigmoid diverticulitis, requiring emergent operative treatment for acute complicated diverticulitis, from 1997 to 2012 at an academic medical center, were identified from a prospectively maintained complications database. Patient characteristics, surgeon, choice of operation, and outcomes including postoperative complications and stoma reversal were noted. The use of primary anastomosis and associated outcomes between colorectal and noncolorectal surgeons were compared.
  
  
  RESULTS
  There were 151 patients who underwent urgent resection during the study period, and 136 met inclusion criteria. Eighty-two resections (65.1%) were performed by noncolorectal surgeons and 44 by colorectal surgeons (34.9%). Noncolorectal surgeons performed more Hartmann procedures (68.3% vs 40.9%, p = 0.01) despite similar demographics, American Society of Anesthesiologists (ASA) classification, and Hinchey stage. Length of stay, time to stoma reversal, ICU days, and postoperative complications were lower in the colorectal group (43.2% vs 16.7, p = 0.02).
  
  
  CONCLUSIONS
  Although patient-specific factors are important, surgeon is a potent predictor of operation performed in the setting of severe acute diverticulitis. A more aggressive approach to primary anastomosis may lower the complication rate after surgical treatment for severe acute diverticulitis.
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Mohammad S
authors.initials: MS
authors.lastname: Jafferji
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT. Electronic address: Neil.Hyman@vtmednet.org.
authors.forename: Neil
authors.initials: N
authors.lastname: Hyman
mesh_terms: D000208:Acute Disease; D013505:Digestive System Surgical Procedures / Q000379:methods; D004238:Diverticulitis / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012720:Severity of Illness Index