Skip to main content

Advertisement

SpringerLink
Log in

Long-term mortality and recurrence in patients treated for colonic diverticulitis with abscess formation: a nationwide register-based cohort study

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The study aimed to investigate long-term mortality, recurrence, and death related to recurrence for patients admitted with acute diverticulitis with abscess formation (Hinchey stage Ib-II).

Methods

The cohort was identified by linking administrative registers for all Danish citizens in years 2000–2012. Patients were identified from ICD-10 discharge codes and stratified according to treatment (antibiotics, percutaneous abscess drainage, or surgery).

Results

From 6,641,672 persons, 3148 patients were identified with acute diverticulitis with abscess formation. Survival was comparable between treatment groups with a 1-year survival of 81–83% and a 5-year survival of 66–67% (p = 0.66). Glucocorticoid usage prior to admission increased risk of mortality with hazard ratio 1.64 (95%CI 1.39–1.93), 1.77 (1.20–2.63), and 1.92 (1.07–3.44) for the antibiotics, drainage, and operative treatment group, respectively. Drainage treatment increased risk of recurrence with sub-distribution hazard (SDH) of 1.52 (1.19–1.95) and operative treatment decreased risk with a SDH of 0.55 (0.32–0.93), both compared with antibiotic treatment (p = 0.0001). Recurrence occurred in 23.6% (18.5–30.1%) of patients in the drainage group, 15.5% (13.9–17.3%) in the antibiotics group, and 9.1% (5.1–16.1%) in the operative group. Recurrence-related mortality was 2.0% (0.9–4.4%) for the drainage group, 1.1% (0.7–1.8%) for the antibiotics group, and 0.6% (0.1–4.3%) for the operative group (p = 0.24). Most recurrences and recurrence-related mortality occurred within the first year after primary admission.

Conclusions

This study with complete national data revealed a high mortality and recurrence rate after diverticular abscesses. Survival was comparable between treatment groups, but patients treated with drainage had significantly higher risk of recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hinchey EJ, Schaal PG, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109

    CAS  PubMed  Google Scholar 

  2. Sher ME, Agachan F, Bortul M, Nogueras JJ, Weiss EG, Wexner SD (1997) Laparoscopic surgery for diverticulitis. Surg Endosc 11:264–267

    Article  CAS  PubMed  Google Scholar 

  3. Gaertner WB, Willis DJ, Madoff RD, Rothenberger DA, Kwaan MR, Belzer GE, Melton GB (2013) Percutaneous drainage of colonic diverticular abscess: is colon resection necessary? Dis Colon Rectum 56:622–626

    Article  PubMed  Google Scholar 

  4. Felder SI, Barmparas G, Lynn J, Murrell Z, Margulies DR, Fleshner P (2013) Can the need for colectomy after computed tomography-guided percutaneous drainage for diverticular abscess be predicted? Am Surg 79:1013–1016

    PubMed  Google Scholar 

  5. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ et al (2012) Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 143:1179–87 e1–3

    Article  PubMed  PubMed Central  Google Scholar 

  6. Brandt D, Gervaz P, Durmishi Y, Platon A, Morel P, Poletti PA (2006) Percutaneous CT scan-guided drainage vs. antibiotherapy alone for Hinchey II diverticulitis: a case-control study. Dis Colon rectum 49:1533–1538

    Article  CAS  PubMed  Google Scholar 

  7. Sallinen VJ, Mentula PJ, Leppaniemi AK (2014) Nonoperative management of perforated diverticulitis with extraluminal air is safe and effective in selected patients. Dis Colon rectum 57:875–881

    Article  PubMed  Google Scholar 

  8. Ambrosetti P, Becker C, Terrier F (2002) Colonic diverticulitis: impact of imaging on surgical management—a prospective study of 542 patients. Eur Radiol 12:1145–1149

    Article  CAS  PubMed  Google Scholar 

  9. Siewert B, Tye G, Kruskal J, Sosna J, Opelka F, Raptopoulos V, Goldberg SN (2006) Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol 186:680–686

    Article  PubMed  Google Scholar 

  10. Kaiser AM, Jiang JK, Lake JP, Ault G, Artinyan A, Gonzalez-Ruiz C, Essani R, Beart RW (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100:910–917

    Article  PubMed  Google Scholar 

  11. Rose J, Parina RP, Faiz O, Chang DC, Talamini MA (2015) Long-term outcomes after initial presentation of diverticulitis. Ann Surg 262:1046–1053

    Article  PubMed  Google Scholar 

  12. Li D, de Mestral C, Baxter NN, McLeod RS, Moineddin R, Wilton AS, et al. Risk of readmission and emergency surgery following nonoperative management of colonic diverticulitis: a population-based analysis. Ann Surg 2014;260:423–30;discussion 30–1

  13. Trenti L, Kreisler E, Galvez A, Golda T, Frago R, Biondo S (2015) Long-term evolution of acute colonic diverticulitis after successful medical treatment. World J Surg 39:266–274

    Article  PubMed  Google Scholar 

  14. van de Wall BJ, Draaisma WA, Consten EC, van der Kaaij RT, Wiezer MJ, Broeders IA (2013) Does the presence of abscesses in diverticular disease prelude surgery? J Gastrointest Surg 17:540–547

    Article  PubMed  Google Scholar 

  15. Hall JF, Roberts PL, Ricciardi R, Read T, Scheirey C, Wald C, Marcello PW, Schoetz DJ (2011) Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence? Dis Colon rectum 54:283–288

    Article  PubMed  Google Scholar 

  16. Levack MM, Savitt LR, Berger DL, Shellito PC, Hodin RA, Rattner DW, Goldberg SM, Bordeianou L (2012) Sigmoidectomy syndrome? Patients’ perspectives on the functional outcomes following surgery for diverticulitis. Dis Colon rectum 55:10–17

    Article  PubMed  Google Scholar 

  17. Gregersen R, Andresen K, Burcharth J, Pommergaard HC, Rosenberg J (2016) Short-term mortality, readmission, and recurrence in treatment of acute diverticulitis with abscess formation: a nationwide register-based cohort study. Int J Color Dis 31:983–990

    Article  Google Scholar 

  18. Schmidt M, Schmidt SA, Sandegaard JL, Ehrenstein V, Pedersen L, Sorensen HT (2015) The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 7:449–490

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pedersen CB (2011) The Danish civil registration system. Scand J Public Health 39:22–25

    Article  PubMed  Google Scholar 

  20. Lynge E, Sandegaard JL, Rebolj M (2011) The Danish National Patient Register. Scand J Public Health 39:30–33

    Article  PubMed  Google Scholar 

  21. Pedersen CB, Gotzsche H, Moller JO, Mortensen PB (2006) The Danish civil registration system. A cohort of eight million persons. Dan Med Bull 53:441–449

    PubMed  Google Scholar 

  22. Furu K, Wettermark B, Andersen M, Martikainen JE, Almarsdottir AB, Sorensen HT (2010) The Nordic countries as a cohort for pharmacoepidemiological research. Basic Clin Pharmacol Toxicol 106:86–94

    Article  CAS  PubMed  Google Scholar 

  23. Kildemoes HW, Sorensen HT, Hallas J (2011) The Danish National Prescription Registry. Scand J Public Health 39:38–41

    Article  PubMed  Google Scholar 

  24. Frank L (2000) When an entire country is a cohort. Science 287:2398–2399

    Article  CAS  PubMed  Google Scholar 

  25. Welbourn HL, Hartley JE (2014) Management of acute diverticulitis and its complications. Indian J Surg 76:429–435

    Article  PubMed  PubMed Central  Google Scholar 

  26. Andersen JC, Bundgaard L, Elbrond H, Laurberg S, Walker LR, Stovring J et al (2012) Danish national guidelines for treatment of diverticular disease. Dan Med J 59:C4453

    PubMed  Google Scholar 

  27. Yurkovich M, Avina-Zubieta JA, Thomas J, Gorenchtein M, Lacaille D (2015) A systematic review identifies valid comorbidity indices derived from administrative health data. J Clin Epidemiol 68:3–14

    Article  PubMed  Google Scholar 

  28. Sharabiani MT, Aylin P, Bottle A (2012) Systematic review of comorbidity indices for administrative data. Med Care 50:1109–1118

    Article  PubMed  Google Scholar 

  29. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139

    Article  PubMed  Google Scholar 

  30. Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27

    Article  CAS  PubMed  Google Scholar 

  31. Andersen PK, Geskus RB, de Witte T, Putter H (2012) Competing risks in epidemiology: possibilities and pitfalls. Int J Epidemiol 41:861–870

    Article  PubMed  PubMed Central  Google Scholar 

  32. Noordzij M, Leffondre K, van Stralen KJ, Zoccali C, Dekker FW, Jager KJ (2013) When do we need competing risks methods for survival analysis in nephrology? Nephrol Dial Transplant 28:2670–2677

    Article  PubMed  Google Scholar 

  33. Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, Sørensen HT, von Elm E, Langan SM, RECORD Working Committee (2015) The REporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med 12:e1001885

    Article  PubMed  PubMed Central  Google Scholar 

  34. Elagili F, Stocchi L, Ozuner G, Dietz DW, Kiran RP (2014) Outcomes of percutaneous drainage without surgery for patients with diverticular abscess. Dis Colon rectum 57:331–336

    Article  PubMed  Google Scholar 

  35. Singh B, May K, Coltart I, Moore NR, Cunningham C (2008) The long-term results of percutaneous drainage of diverticular abscess. Ann R Coll Surg Engl 90:297–301

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Eglinton T, Nguyen T, Raniga S, Dixon L, Dobbs B, Frizelle FA (2010) Patterns of recurrence in patients with acute diverticulitis. Br J Surg 97:952–957

    Article  CAS  PubMed  Google Scholar 

  37. Broderick-Villa G, Burchette RJ, CJ C, AM A, Haigh PI (2005) Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg 140:576–581

    Article  PubMed  Google Scholar 

  38. Kvasnovsky CL, Papagrigoriadis S, Bjarnason I (2014) Increased diverticular complications with nonsteriodal anti-inflammatory drugs and other medications: a systematic review and meta-analysis. Color Dis 16:O189–O196

    Article  CAS  Google Scholar 

  39. Humes DJ, Fleming KM, Spiller RC, West J (2011) Concurrent drug use and the risk of perforated colonic diverticular disease: a population-based case-control study. Gut 60:219–224

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark

    Rasmus Gregersen, Kristoffer Andresen & Jacob Rosenberg

  2. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Rasmus Gregersen, Kristoffer Andresen & Jacob Rosenberg

  3. Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark

    Jakob Burcharth

  4. Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark

    Hans-Christian Pommergaard

Authors
  1. Rasmus Gregersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristoffer Andresen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jakob Burcharth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hans-Christian Pommergaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacob Rosenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rasmus Gregersen.

Ethics declarations

Conflict of interest

Dr. Rosenberg reports personal fees from Bard and personal fees from Merck, outside the submitted work, and no additional, potential conflict of interests. The remaining authors declare that they have no financial interests or potential conflicts of interest.

Electronic supplementary materials

ESM 1

Full model for the risk of recurrence with death as a competing risk (PDF 627 kb)

ESM 2

RECORD Check-list (PDF 319 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gregersen, R., Andresen, K., Burcharth, J. et al. Long-term mortality and recurrence in patients treated for colonic diverticulitis with abscess formation: a nationwide register-based cohort study. Int J Colorectal Dis 33, 431–440 (2018). https://doi.org/10.1007/s00384-018-2990-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-018-2990-1

Keywords

Search

Navigation