title: Emergency surgery for perforated diverticulitis in the immunosuppressed patient.
abstract: OBJECTIVE
  Immunosuppression is believed to worsen outcomes for patients who require surgery for perforated diverticulitis. The aim of this study was to compare surgical outcomes between immunocompromised and immunocompetent patients undergoing surgery for complicated diverticulitis.
  
  
  METHODS
  All patients who underwent emergency surgery for complicated diverticulitis between 2004 and 2012 in a single unit were studied. Patients were classified as immunosuppressed (group I) or immunocompetent (group II). Operation type and postoperative morbidity and mortality were compared between groups. The impact of operating surgeons' specialization and the Peritonitis Severity Score (PSS) were also evaluated to determine their impact on the restoration of gastrointestinal (GI) continuity.
  
  
  RESULTS
  One-hundred and sixteen patients (mean age: 63.7 years), 41.4% women, were included. Fifty-three (45.7%) patients were immunosuppressed (group I): 42 underwent Hartmann's procedure (HP) (79.2%), nine (17.0%) underwent resection and primary anastomosis (RPA) with ileostomy (IL) and two (3.8%) underwent RPA without IL. In group II, 15 HP (23.8%), nine RPA with IL (14.3%) and 39 RPA without IL (61.9%) were performed. Postoperative morbidity and mortality were 79.2% and 26.4%, respectively, in group I and 63.5% and 6.3%, respectively, in group II. The overall mean PSS was 9.5, with a mean PSS of 11.1 in group I and of 8.1 in group II. The decision to perform a primary anastomosis differed significantly between colorectal surgeons and general surgeons in the patients with a PSS of 9-10-11.
  
  
  CONCLUSIONS
  In immunocompromised patients, RPA with IL can be a safe surgical option, whereas HP should be reserved for patients with a PSS of > 11. Colorectal surgical specialization is associated with higher rates of restoration of GI continuity in patients with perforated diverticulitis, especially in patients with an intermediate PSS score. Evaluation of each patient's PSS facilitates decision making in surgery for perforated diverticulitis.
authors.affiliation: Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Golda
authors.forename: E
authors.initials: E
authors.lastname: Kreisler
authors.forename: C
authors.initials: C
authors.lastname: Mercader
authors.forename: R
authors.initials: R
authors.lastname: Frago
authors.forename: L
authors.initials: L
authors.lastname: Trenti
authors.forename: S
authors.initials: S
authors.lastname: Biondo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000276:immunology / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery*; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007416:Intestinal Perforation / Q000209:etiology / Q000276:immunology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Diverticulitis; Peritonitis Severity Score; immunosuppression; left colonic perforation