%0 Journal Article
%T Diverticulitis with abscess formation: Outcomes of non-operative management and nomogram for predicting emergency surgery: The Diplicab Study Collaborative Group.
%A Ocaña J
%A García-Pérez JC
%A Fernández-Martínez D
%A Aguirre I
%A Pascual I
%A Lora P
%A Espin E
%A Labalde-Martínez M
%A León C
%A Pastor-Peinado P
%A López-Domínguez C
%A Muñoz-Plaza N
%A Valle A
%A Dujovne P
%A Alías D
%A Pérez-Santiago L
%A Correa A
%A Carmona M
%A Díez MM
%A Timoteo A
%A Salvans S
%A Medina RE
%A Gómez T
%A Fernández-Vega L
%A Peña E
%A García-González JM
%A Blanco-Antona F
%A Fábregues AI
%A Sagarra E
%A Viejo E
%A Moreno A
%A Fernández-Cebrián JM
%A Die J
%A  
%J Surgery
%V 174
%N 3
%D 2023 09 27
%M 37385866
%F 4.348
%R 10.1016/j.surg.2023.05.016
%X 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.<BR>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.<BR>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).<BR>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.