title: Predictive factors for colonic resection in patients less than 49 years with symptomatic diverticular disease.
abstract: BACKGROUND
  Diverticular disease is a condition strongly associated with low-fiber intake and obesity. There have been reports of an increasing incidence in younger individuals ranging from 12% to 21% of all cases. The aim of this study was to evaluate the management of complicated diverticular disease in patients less than 49 years and attempt to identify factors predictive of a more virulent course.
  
  
  METHODS
  An analysis of a prospectively updated database of all patients admitted with a primary diagnosis of acute diverticulitis from 2005 to 2013 was performed. Data collected included age, length of stay, inflammatory markers on admission, use of computed tomography (CT), and Hinchey Classification. SPSS version 22 was used for statistical analysis, and a P value of .05 or less was considered significant.
  
  
  RESULTS
  A total of 120 (54 female and 66 male) patients less than 49 (28 to 49, 42.1) years were noted to have a diagnosis of acute diverticulitis. Twelve patients (10%) required colonic resection for complicated diverticulitis. Histological evaluation revealed 5 cases of stricture, 2 obstruction, and 5 perforations. On multivariate analysis, predictors of operative intervention and/or colonic resection included, (hazard ratio [95% confidence interval]) patients aged 40 to 49 years (.92 [.9 to .95]) and elevated C-reactive protein on index admission (1.4 [1.32 to 1.54]). Females were less likely to undergo colonic resection compared with males (1.18 [1.15 to 1.2]). Median length of stay was 4 days (1 to 48) for patients managed nonoperatively and 13 days (5 to 27) for those who underwent surgery.
  
  
  CONCLUSIONS
  Most younger patients with acute diverticulitis can be treated successfully by conservative means. However, a proportion of patients require aggressive surgical management.
authors.affiliation: Department of Surgery, Mayo General Hospital, Westport Road, Castlebar, County Mayo, Ireland. Electronic address: stephenmurphy@rcsi.ie.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Murphy
authors.affiliation: Department of Surgery, Mayo General Hospital, Westport Road, Castlebar, County Mayo, Ireland.
authors.forename: Peadar S
authors.initials: PS
authors.lastname: Waters
authors.affiliation: Department of Surgery, Mayo General Hospital, Westport Road, Castlebar, County Mayo, Ireland.
authors.forename: Ronan M
authors.initials: RM
authors.lastname: Waldron
authors.affiliation: Department of Pathology, Mayo General Hospital, Castlebar, County Mayo, Ireland.
authors.forename: Fadel
authors.initials: F
authors.lastname: Bennani
authors.affiliation: Department of Radiology, Mayo General Hospital, Castlebar, County Mayo, Ireland.
authors.forename: Ronan S
authors.initials: RS
authors.lastname: Ryan
authors.affiliation: Department of Surgery, Mayo General Hospital, Westport Road, Castlebar, County Mayo, Ireland.
authors.forename: Waqar
authors.initials: W
authors.lastname: Khan
authors.affiliation: Department of Surgery, Mayo General Hospital, Westport Road, Castlebar, County Mayo, Ireland.
authors.forename: Iqbal Z
authors.initials: IZ
authors.lastname: Khan
authors.affiliation: Department of Surgery, Mayo General Hospital, Westport Road, Castlebar, County Mayo, Ireland; Department of Surgery, National University of Ireland, Galway, Ireland.
authors.forename: Kevin
authors.initials: K
authors.lastname: Barry
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D002097:C-Reactive Protein / Q000032:analysis*; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D004239:Diverticulitis, Colonic / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D004241:Diverticulum, Colon / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: Diverticular disease; Diverticulitis; Predictive factors; Surgical intervention; Younger patients