Rodrigo Moises de Almeida Leite, Rocco Ricciardi, Joh Hama, Isabela Monforte Toledo, Ana Sarah Portilho, Lucas de Araujo Horcel, Rafael Vaz Pandini, Lucas Cata Preta Stolzemburg, Lucas Soares Gerbasi, Francisco Tustumi, Victor Edmond Seid, Sergio Eduardo Alonso Araujo
{"title":"评估急诊复杂憩室炎的最佳手术方法:来自国家手术质量改进计划数据库的队列研究结果。","authors":"Rodrigo Moises de Almeida Leite, Rocco Ricciardi, Joh Hama, Isabela Monforte Toledo, Ana Sarah Portilho, Lucas de Araujo Horcel, Rafael Vaz Pandini, Lucas Cata Preta Stolzemburg, Lucas Soares Gerbasi, Francisco Tustumi, Victor Edmond Seid, Sergio Eduardo Alonso Araujo","doi":"10.1177/10926429251370996","DOIUrl":null,"url":null,"abstract":"<p><p><b><i>Background:</i></b> The optimal surgical approach for complicated diverticulitis in the emergency setting remains controversial. This retrospective cohort study aimed to investigate the clinical outcomes associated with Hartmann's procedure (HP) and primary anastomosis (with and without ileostomy) in patients diagnosed with complicated diverticulitis. <b><i>Methods:</i></b> Data were collected from the American College of Surgeons-National Surgical Quality Improvement Program participant user files from 2016 to 2021. A total of 25,458 patients with acute diverticulitis and emergency surgery were included. The patients were categorized into three groups: those who underwent HP, those who underwent primary anastomosis with ileostomy and those who underwent primary anastomosis without ileostomy. The primary outcomes assessed were medical-related morbidity and anastomotic leak. Secondary outcomes included mortality, unplanned readmission, and length of in-hospital stay. <b><i>Results:</i></b> Compared to patients who underwent the primary anastomosis procedure, the HP group displayed significantly higher rates of medical-related morbidity, and higher mortality rates, even after multivariate adjustment and propensity score analysis. Patients who received the ileostomy exhibited a statistically significantly higher medical-related morbidity and unplanned readmission rates. However, aside from these outcomes, the two groups did not exhibit significantly different rates in any of the other outcomes studied, including anastomotic leak. In patients with septic shock, primary anastomosis without diverting loop ileostomy was associated with significantly lower unplanned readmission when compared with the ileostomy group. <b><i>Conclusion:</i></b> Primary anastomosis demonstrated superior outcomes when compared with HP, and there are potential benefits of avoiding a diverting loop ileostomy. Hemodynamical status was not associated with worse prognosis in the primary anastomosis group.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"721-725"},"PeriodicalIF":1.1000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessing the Optimal Surgical Approach for Complicated Diverticulitis in the Emergency Setting: Results from a Cohort Study Using National Surgical Quality Improvement Program Database.\",\"authors\":\"Rodrigo Moises de Almeida Leite, Rocco Ricciardi, Joh Hama, Isabela Monforte Toledo, Ana Sarah Portilho, Lucas de Araujo Horcel, Rafael Vaz Pandini, Lucas Cata Preta Stolzemburg, Lucas Soares Gerbasi, Francisco Tustumi, Victor Edmond Seid, Sergio Eduardo Alonso Araujo\",\"doi\":\"10.1177/10926429251370996\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Background:</i></b> The optimal surgical approach for complicated diverticulitis in the emergency setting remains controversial. This retrospective cohort study aimed to investigate the clinical outcomes associated with Hartmann's procedure (HP) and primary anastomosis (with and without ileostomy) in patients diagnosed with complicated diverticulitis. <b><i>Methods:</i></b> Data were collected from the American College of Surgeons-National Surgical Quality Improvement Program participant user files from 2016 to 2021. A total of 25,458 patients with acute diverticulitis and emergency surgery were included. The patients were categorized into three groups: those who underwent HP, those who underwent primary anastomosis with ileostomy and those who underwent primary anastomosis without ileostomy. The primary outcomes assessed were medical-related morbidity and anastomotic leak. Secondary outcomes included mortality, unplanned readmission, and length of in-hospital stay. <b><i>Results:</i></b> Compared to patients who underwent the primary anastomosis procedure, the HP group displayed significantly higher rates of medical-related morbidity, and higher mortality rates, even after multivariate adjustment and propensity score analysis. Patients who received the ileostomy exhibited a statistically significantly higher medical-related morbidity and unplanned readmission rates. However, aside from these outcomes, the two groups did not exhibit significantly different rates in any of the other outcomes studied, including anastomotic leak. In patients with septic shock, primary anastomosis without diverting loop ileostomy was associated with significantly lower unplanned readmission when compared with the ileostomy group. <b><i>Conclusion:</i></b> Primary anastomosis demonstrated superior outcomes when compared with HP, and there are potential benefits of avoiding a diverting loop ileostomy. Hemodynamical status was not associated with worse prognosis in the primary anastomosis group.</p>\",\"PeriodicalId\":50166,\"journal\":{\"name\":\"Journal of Laparoendoscopic & Advanced Surgical Techniques\",\"volume\":\" \",\"pages\":\"721-725\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Laparoendoscopic & Advanced Surgical Techniques\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/10926429251370996\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Laparoendoscopic & Advanced Surgical Techniques","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10926429251370996","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/21 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
Assessing the Optimal Surgical Approach for Complicated Diverticulitis in the Emergency Setting: Results from a Cohort Study Using National Surgical Quality Improvement Program Database.
Background: The optimal surgical approach for complicated diverticulitis in the emergency setting remains controversial. This retrospective cohort study aimed to investigate the clinical outcomes associated with Hartmann's procedure (HP) and primary anastomosis (with and without ileostomy) in patients diagnosed with complicated diverticulitis. Methods: Data were collected from the American College of Surgeons-National Surgical Quality Improvement Program participant user files from 2016 to 2021. A total of 25,458 patients with acute diverticulitis and emergency surgery were included. The patients were categorized into three groups: those who underwent HP, those who underwent primary anastomosis with ileostomy and those who underwent primary anastomosis without ileostomy. The primary outcomes assessed were medical-related morbidity and anastomotic leak. Secondary outcomes included mortality, unplanned readmission, and length of in-hospital stay. Results: Compared to patients who underwent the primary anastomosis procedure, the HP group displayed significantly higher rates of medical-related morbidity, and higher mortality rates, even after multivariate adjustment and propensity score analysis. Patients who received the ileostomy exhibited a statistically significantly higher medical-related morbidity and unplanned readmission rates. However, aside from these outcomes, the two groups did not exhibit significantly different rates in any of the other outcomes studied, including anastomotic leak. In patients with septic shock, primary anastomosis without diverting loop ileostomy was associated with significantly lower unplanned readmission when compared with the ileostomy group. Conclusion: Primary anastomosis demonstrated superior outcomes when compared with HP, and there are potential benefits of avoiding a diverting loop ileostomy. Hemodynamical status was not associated with worse prognosis in the primary anastomosis group.
期刊介绍:
Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.