Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case-control study.
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Ошибки и ограничения
История · было → стало
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Podda Mauro, Ceresoli Marco, Di Martino Marcello, Ortenzi Monica, Pellino Gianluca, Pata Francesco, Ielpo Benedetto, Murzi Valentina, Balla Andrea, Lepiane Pasquale, Tamini Nicolo', De Carlo Giulia, Davolio Alessia, Di Saverio Salomone, Cardinali Luca, Botteri Emanuele, Vettoretto Nereo, Gelera Pier Paolo, De Simone Belinda, Grasso Antonella, Clementi Marco, Meloni Danilo, Poillucci Gaetano, Favi Francesco, Rizzo Roberta, Montori Giulia, Procida Giuseppa, Recchia Irene, Agresta Ferdinando, Virdis Francesco, Cioffi Stefano Piero Bernardo, Pellegrini Martina, Sartelli Massimo, Coccolini Federico, Catena Fausto, Pisanu Adolfo
Аннотация
METHODS: This study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed.
RESULTS: Failure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI - 0.66;3.70, P = 0.23).
CONCLUSIONS: Non-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.