Abstract：
To assess short- and long-term outcomes from non-surgical management of diverticulitis with abscess formation and to develop a nomogram to predict emergency surgery.
This nationwide retrospective cohort study was performed in 29 Spanish referral centers, including patients with a first episode of a diverticular abscess (modified Hinchey Ib-II) from 2015 to 2019. Emergency surgery, complications, and recurrent episodes were analyzed. Regression analysis was used to assess risk factors, and a nomogram for emergency surgery was designed.
Overall, 1,395 patients were included (1,078 Hinchey Ib and 317 Hinchey II). Most (1,184, 84.9%) patients were treated with antibiotics without percutaneous drainage, and 194 (13.90%) patients required emergency surgery during admission. Percutaneous drainage (208 patients) was associated with a lower risk of emergency surgery in patients with abscesses of ≥5 cm (19.9% vs 29.3%, P = .035; odds ratio 0.59 [0.37-0.96]). The multivariate analysis showed that immunosuppression treatment, C-reactive protein (odds ratio: 1.003; 1.001-1.005), free pneumoperitoneum (odds ratio: 3.01; 2.04-4.44), Hinchey II (odds ratio: 2.15; 1.42-3.26), abscess size 3 to 4.9 cm (odds ratio: 1.87; 1.06-3.29), abscess size ≥5 cm (odds ratio: 3.62; 2.08-6.32), and use of morphine (odds ratio: 3.68; 2.29-5.92) were associated with emergency surgery. A nomogram was developed with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.77-0.85).
Percutaneous drainage must be considered in abscesses ≥5 cm to reduce emergency surgery rates; however, there are insufficient data to recommend it in smaller abscesses. The use of the nomogram could help the surgeon develop a targeted approach.
This nationwide retrospective cohort study was performed in 29 Spanish referral centers, including patients with a first episode of a diverticular abscess (modified Hinchey Ib-II) from 2015 to 2019. Emergency surgery, complications, and recurrent episodes were analyzed. Regression analysis was used to assess risk factors, and a nomogram for emergency surgery was designed.
Overall, 1,395 patients were included (1,078 Hinchey Ib and 317 Hinchey II). Most (1,184, 84.9%) patients were treated with antibiotics without percutaneous drainage, and 194 (13.90%) patients required emergency surgery during admission. Percutaneous drainage (208 patients) was associated with a lower risk of emergency surgery in patients with abscesses of ≥5 cm (19.9% vs 29.3%, P = .035; odds ratio 0.59 [0.37-0.96]). The multivariate analysis showed that immunosuppression treatment, C-reactive protein (odds ratio: 1.003; 1.001-1.005), free pneumoperitoneum (odds ratio: 3.01; 2.04-4.44), Hinchey II (odds ratio: 2.15; 1.42-3.26), abscess size 3 to 4.9 cm (odds ratio: 1.87; 1.06-3.29), abscess size ≥5 cm (odds ratio: 3.62; 2.08-6.32), and use of morphine (odds ratio: 3.68; 2.29-5.92) were associated with emergency surgery. A nomogram was developed with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.77-0.85).
Percutaneous drainage must be considered in abscesses ≥5 cm to reduce emergency surgery rates; however, there are insufficient data to recommend it in smaller abscesses. The use of the nomogram could help the surgeon develop a targeted approach.
摘要：
背景：评估伴有脓肿形成的憩室炎非手术治疗的短期和长期结果，并制定列线图以预测急诊手术。
方法：这项全国性的回顾性队列研究在29个西班牙转诊中心进行，包括2015年至2019年首次发作憩室脓肿（改良HincheyIb-II）的患者。急诊手术,并发症,并对反复发作进行了分析.回归分析用于评估危险因素，并设计了急诊手术的列线图。
结果：总体而言，包括1,395例患者（1,078HincheyIb和317HincheyII）。大多数（1,184，84.9％）患者接受了抗生素治疗而没有经皮引流，194例(13.90%)患者在入院期间需要急诊手术。经皮穿刺引流术（208例）与脓肿≥5cm的急诊手术风险较低（19.9%vs29.3%，P=.035；赔率比0.59[0.37-0.96]）。多因素分析显示,免疫抑制治疗,C反应蛋白（比值比：1.003;1.001-1.005），自由气腹（比值比：3.01;2.04-4.44），欣奇二世(赔率比：2.15；1.42-3.26)，脓肿大小3至4.9厘米（赔率比：1.87;1.06-3.29），脓肿大小≥5cm（比值比：3.62;2.08-6.32），吗啡的使用(比值比:3.68;2.29-5.92)与急诊手术相关。建立了一个列线图，受试者工作特征曲线下的面积为0.81（95％置信区间：0.77-0.85）。
结论：在≥5cm的脓肿中必须考虑经皮引流，以降低急诊手术率；然而，没有足够的数据推荐它在较小的脓肿。使用列线图可以帮助外科医生开发有针对性的方法。
方法：这项全国性的回顾性队列研究在29个西班牙转诊中心进行，包括2015年至2019年首次发作憩室脓肿（改良HincheyIb-II）的患者。急诊手术,并发症,并对反复发作进行了分析.回归分析用于评估危险因素，并设计了急诊手术的列线图。
结果：总体而言，包括1,395例患者（1,078HincheyIb和317HincheyII）。大多数（1,184，84.9％）患者接受了抗生素治疗而没有经皮引流，194例(13.90%)患者在入院期间需要急诊手术。经皮穿刺引流术（208例）与脓肿≥5cm的急诊手术风险较低（19.9%vs29.3%，P=.035；赔率比0.59[0.37-0.96]）。多因素分析显示,免疫抑制治疗,C反应蛋白（比值比：1.003;1.001-1.005），自由气腹（比值比：3.01;2.04-4.44），欣奇二世(赔率比：2.15；1.42-3.26)，脓肿大小3至4.9厘米（赔率比：1.87;1.06-3.29），脓肿大小≥5cm（比值比：3.62;2.08-6.32），吗啡的使用(比值比:3.68;2.29-5.92)与急诊手术相关。建立了一个列线图，受试者工作特征曲线下的面积为0.81（95％置信区间：0.77-0.85）。
结论：在≥5cm的脓肿中必须考虑经皮引流，以降低急诊手术率；然而，没有足够的数据推荐它在较小的脓肿。使用列线图可以帮助外科医生开发有针对性的方法。
