title: Uncomplicated Acute Diverticulitis: Identifying Risk Factors for Severe Outcomes.
abstract: The management of uncomplicated (Modified Hinchey Classification Ia) acute diverticulitis (AD) has become increasingly conservative, with a focus on symptomatic relief and supportive management. Clear criteria for patient selection are required to implement this safely. This retrospective study aimed to identify risk factors for severe clinical course in patients with uncomplicated AD.
  
  
  
  Patients admitted to General Surgery at two New Zealand tertiary centres over a period of 18 months were included. Univariate and multivariate analyses were carried out in order to identify factors associated with a more severe clinical course. This was defined by three endpoints: need for procedural intervention, admission >7 days and 30-day readmission; these were analysed separately and as a combined outcome.
  
  
  
  Uncomplicated AD was identified in 319 patients. Fifteen patients (5%) required procedural intervention; this was associated with SIRS (OR 3.92). Twenty-two (6.9%) patients were admitted for >7 days; this was associated with patient-reported pain score >8/10 (OR 5.67). Thirty-one patients (9.8%) required readmission within 30 days; this was associated with pain score >8/10 (OR 6.08) and first episode of AD (OR 2.47). Overall, 49 patients had a severe clinical course, and associated factors were regular steroid/immunomodulator use (OR 4.34), pain score >8/10 (OR 5.9) and higher temperature (OR 1.51) and CRP ≥200 (OR 4.1).
  
  
  
  SIRS, high pain score and CRP, first episode and regular steroid/immunomodulator use were identified as predictors of worse outcome in uncomplicated AD. These findings have the potential to inform prospective treatment decisions in this patient group.
authors.affiliation: Department of Surgery, University of Auckland, ACH Support Building, Park Road, Grafton, Auckland, New Zealand.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Jaung
authors.affiliation: Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland, New Zealand.
authors.forename: Malsha
authors.initials: M
authors.lastname: Kularatna
authors.affiliation: Department of Surgery, University of Auckland, ACH Support Building, Park Road, Grafton, Auckland, New Zealand.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Robertson
authors.affiliation: Department of Surgery, University of Auckland, ACH Support Building, Park Road, Grafton, Auckland, New Zealand.
authors.forename: Ryash
authors.initials: R
authors.lastname: Vather
authors.affiliation: Department of Gastroenterology and Hepatology, Auckland City Hospital, Auckland, New Zealand.
authors.forename: David
authors.initials: D
authors.lastname: Rowbotham
authors.affiliation: Department of Surgery, University of Auckland, ACH Support Building, Park Road, Grafton, Auckland, New Zealand.|Department of Surgery, Counties Manukau Health, Auckland, New Zealand.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: MacCormick
authors.affiliation: Department of Surgery, University of Auckland, ACH Support Building, Park Road, Grafton, Auckland, New Zealand. i.bissett@auckland.ac.nz.|Department of Surgery, Auckland City Hospital, Auckland, New Zealand. i.bissett@auckland.ac.nz.
authors.forename: Ian P
authors.initials: IP
authors.lastname: Bissett
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001831:Body Temperature; D002097:C-Reactive Protein / Q000378:metabolism; D000072700:Conservative Treatment; D004238:Diverticulitis / Q000097:blood / Q000150:complications / Q000601:surgery / Q000628:therapy*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010147:Pain Measurement; D010359:Patient Readmission; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D013256:Steroids; D002097:C-Reactive Protein