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.
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。