Abstract：
BACKGROUND: Acute complicated diverticulitis poses a substantial burden to individual patients and the health care system. A significant proportion of the cases necessitate emergency operations. The choice between Hartmann\'s procedure and primary anastomosis with diverting loop ileostomy remains controversial.
METHODS: Using American College of Surgeons National Surgical Quality Improvement Program patient user file data from 2012 to 2020, patients undergoing Hartmann\'s procedure and primary anastomosis with diverting loop ileostomy for nonelective sigmoidectomy for complicated diverticulitis were identified. Major adverse events, 30-day mortality, perioperative complications, operative duration, reoperation, and 30-day readmissions were assessed.
RESULTS: Of 16,921 cases, 6.3% underwent primary anastomosis with diverting loop ileostomy, showing a rising trend from 5.3% in 2012 to 8.4% in 2020. Primary anastomosis with diverting loop ileostomy patients, compared to Hartmann\'s procedure, had similar demographics and fewer severe comorbidities. Primary anastomosis with diverting loop ileostomy exhibited lower rates of major adverse events (24.6% vs 29.3%, P = .001). After risk adjustment, primary anastomosis with diverting loop ileostomy had similar risks of major adverse events and 30-day mortality compared to Hartmann\'s procedure. While having lower odds of respiratory (adjusted odds ratio 0.61, 95% confidence interval 0.45-0.83) and infectious (adjusted odds ratio 0.78, 95% confidence interval 0.66-0.93) complications, primary anastomosis with diverting loop ileostomy was associated with a 36-minute increment in operative duration and increased odds of 30-day readmission (adjusted odds ratio 1.30, 95% confidence interval 1.07-1.57) compared to Hartmann\'s procedure.
CONCLUSIONS: Primary anastomosis with diverting loop ileostomy displayed comparable odds of major adverse events compared to Hartmann\'s procedure in acute complicated diverticulitis while mitigating infectious and respiratory complication risks. However, primary anastomosis with diverting loop ileostomy was associated with longer operative times and greater odds of 30-day readmission. Evolving guidelines and increasing primary anastomosis with diverting loop ileostomy use suggest a shift favoring primary anastomosis, especially in complicated diverticulitis. Future investigation of disparities in surgical approaches and patient outcomes is warranted to optimize acute diverticulitis care pathways.
METHODS: Using American College of Surgeons National Surgical Quality Improvement Program patient user file data from 2012 to 2020, patients undergoing Hartmann\'s procedure and primary anastomosis with diverting loop ileostomy for nonelective sigmoidectomy for complicated diverticulitis were identified. Major adverse events, 30-day mortality, perioperative complications, operative duration, reoperation, and 30-day readmissions were assessed.
RESULTS: Of 16,921 cases, 6.3% underwent primary anastomosis with diverting loop ileostomy, showing a rising trend from 5.3% in 2012 to 8.4% in 2020. Primary anastomosis with diverting loop ileostomy patients, compared to Hartmann\'s procedure, had similar demographics and fewer severe comorbidities. Primary anastomosis with diverting loop ileostomy exhibited lower rates of major adverse events (24.6% vs 29.3%, P = .001). After risk adjustment, primary anastomosis with diverting loop ileostomy had similar risks of major adverse events and 30-day mortality compared to Hartmann\'s procedure. While having lower odds of respiratory (adjusted odds ratio 0.61, 95% confidence interval 0.45-0.83) and infectious (adjusted odds ratio 0.78, 95% confidence interval 0.66-0.93) complications, primary anastomosis with diverting loop ileostomy was associated with a 36-minute increment in operative duration and increased odds of 30-day readmission (adjusted odds ratio 1.30, 95% confidence interval 1.07-1.57) compared to Hartmann\'s procedure.
CONCLUSIONS: Primary anastomosis with diverting loop ileostomy displayed comparable odds of major adverse events compared to Hartmann\'s procedure in acute complicated diverticulitis while mitigating infectious and respiratory complication risks. However, primary anastomosis with diverting loop ileostomy was associated with longer operative times and greater odds of 30-day readmission. Evolving guidelines and increasing primary anastomosis with diverting loop ileostomy use suggest a shift favoring primary anastomosis, especially in complicated diverticulitis. Future investigation of disparities in surgical approaches and patient outcomes is warranted to optimize acute diverticulitis care pathways.
摘要：
背景：急性复杂性憩室炎给个体患者和卫生保健系统带来了巨大的负担。很大一部分案件需要紧急行动。在Hartmann术式和原发性吻合术与分流回肠造口术之间的选择仍然存在争议。
方法：使用2012年至2020年的美国外科医生协会国家手术质量改进计划患者用户文件数据，确定了接受Hartmann手术和初次吻合术合并分流回肠造口术的非选择性乙状结肠切除术治疗复杂性憩室炎的患者。主要不良事件,30天死亡率，围手术期并发症,手术持续时间,再操作,并评估了30天的再入院时间.
结果：在16,921例中，6.3%的人接受了原发性吻合术和分流回肠造口术，呈现上升趋势，从2012年的5.3%上升到2020年的8.4%。原发性吻合术伴分流回肠造口术患者，与哈特曼的手术相比，具有相似的人口统计学特征和较少的严重合并症。初次吻合术合并分流回肠造口术的主要不良事件发生率较低（24.6%vs29.3%，P=.001)。风险调整后，与Hartmann's手术相比,初次吻合术合并分流回肠造口术的主要不良事件和30日死亡率风险相似.虽然有较低的几率呼吸（调整的比值比0.61，95％置信区间0.45-0.83）和感染（调整的比值比0.78，95％置信区间0.66-0.93）并发症，与Hartmann's手术相比,初次吻合术合并分流回肠造口术的手术时间延长36分钟,再入院30天的几率增加(校正比值比1.30,95%置信区间1.07-1.57).
结论：在急性复杂憩室炎中，与Hartmann手术相比，初次吻合术合并分流回肠造口术显示出相当的主要不良事件几率，同时减轻了感染和呼吸道并发症的风险。然而,初次吻合术合并分流回肠造口术与更长的手术时间和更大的30天再入院几率相关.不断发展的指南和增加的原发性吻合术与转移回肠造口术的使用表明了有利于原发性吻合术的转变。尤其是复杂憩室炎。有必要对手术方法和患者预后的差异进行进一步研究，以优化急性憩室炎的护理途径。
方法：使用2012年至2020年的美国外科医生协会国家手术质量改进计划患者用户文件数据，确定了接受Hartmann手术和初次吻合术合并分流回肠造口术的非选择性乙状结肠切除术治疗复杂性憩室炎的患者。主要不良事件,30天死亡率，围手术期并发症,手术持续时间,再操作,并评估了30天的再入院时间.
结果：在16,921例中，6.3%的人接受了原发性吻合术和分流回肠造口术，呈现上升趋势，从2012年的5.3%上升到2020年的8.4%。原发性吻合术伴分流回肠造口术患者，与哈特曼的手术相比，具有相似的人口统计学特征和较少的严重合并症。初次吻合术合并分流回肠造口术的主要不良事件发生率较低（24.6%vs29.3%，P=.001)。风险调整后，与Hartmann's手术相比,初次吻合术合并分流回肠造口术的主要不良事件和30日死亡率风险相似.虽然有较低的几率呼吸（调整的比值比0.61，95％置信区间0.45-0.83）和感染（调整的比值比0.78，95％置信区间0.66-0.93）并发症，与Hartmann's手术相比,初次吻合术合并分流回肠造口术的手术时间延长36分钟,再入院30天的几率增加(校正比值比1.30,95%置信区间1.07-1.57).
结论：在急性复杂憩室炎中，与Hartmann手术相比，初次吻合术合并分流回肠造口术显示出相当的主要不良事件几率，同时减轻了感染和呼吸道并发症的风险。然而,初次吻合术合并分流回肠造口术与更长的手术时间和更大的30天再入院几率相关.不断发展的指南和增加的原发性吻合术与转移回肠造口术的使用表明了有利于原发性吻合术的转变。尤其是复杂憩室炎。有必要对手术方法和患者预后的差异进行进一步研究，以优化急性憩室炎的护理途径。
