title: Identification of diverticulitis patients at high risk for recurrence and poor outcomes.
abstract: BACKGROUND
  Currently, the indications for elective surgery for patients who have recovered from an acute diverticulitis (AD) are controversial. We examined the natural history of AD in New York and identified risk factors for recurrent admissions and poor outcome to create a simple model to produce risk stratification groups. Poor outcome was defined as complicated disease, emergency surgery, or mortality during any recurrent admission.
  
  
  METHODS
  Data on adult diverticulitis admissions between 1985 and 2006 were extracted from the state discharge database; recurrences were monitored using unique identifiers. Survivors of nonoperative management who did not undergo subsequent elective surgery were considered eligible for recurrence. Clinical variables from the first admission with significant association with poor outcomes or recurrence were identified using multivariable analysis and were used to create risk stratification groups.
  
  
  RESULTS
  A total of 237,879 individuals were identified. Of the 181,115 patients eligible for recurrence after one admission, 8.7% recurred; of the patients eligible for recurrence after two admissions, 23.2% recurred. Complicated AD or abscess and age less than 50 years allowed the creation of discrete risk groups for both recurrence and poor outcome.
  
  
  CONCLUSIONS
  The majority of patients (91.3%) had no further admissions for AD. However, patients admitted for recurrence were increasingly likely to require subsequent admissions. Patients with complicated AD at the first admission, specifically abscess, had a high risk of recurrence and poor outcome and should be offered surgery. Younger patients also had higher recurrence and poor outcomes. We provide a risk stratification model to help identify patients at high risk for recurrence and poor outcome.
  
  
  METHODS
  Therapeutic study, level IV; epidemiologic/prognostic study, level III.
authors.affiliation: From the Department of Surgery (V.P.H.), Jamaica Hospital Medical Center, Jamaica; Memorial Sloan Kettering Cancer Center (G.M.N.); and Department of Surgery (J.W.M., S.W.L.), Weill Cornell Medical College, New York, New York.
authors.forename: Vanessa P
authors.initials: VP
authors.lastname: Ho
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Nash
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Milsom
authors.forename: Sang W
authors.initials: SW
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome