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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: BACKGROUND, OBJECTIVE, METHODS, METHODS, METHODS, METHODS, METHODS, RESULTS. Meshes: Acute Disease, Adult, Age Factors, Aged, Aged, 80 and over, Colectomy, Comorbidity, Diverticulitis, Colonic, Drainage, Elective Surgical Procedures, Emergencies, Female, Follow-Up Studies, Hospitalization, Humans, Male, Middle Aged, Recurrence, Retrospective Studies.
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Does hospitalization for acute diverticulitis mandate routine elective colectomy? Context: Previous studies suggest that elective colectomy is often required after an episode of acute diverticulitis. Acute diverticulitis initially treated nonoperatively does not require elective colectomy. Retrospective cohort study. Twelve Kaiser Permanente hospitals in Southern California. Three thousand one hundred sixty-five patients with acute diverticulitis. Colectomy or nonoperative treatment with or without percutaneous abscess drainage. Recurrent diverticulitis. Emergency colectomy was performed in 614 patients (19.4%). Nonoperative treatment was initially used in 2551 patients (80.6%). Of these, 185 patients (7.3%) had an elective colectomy and the remaining 2366 patients (92.7%) did not. Factors associated with undergoing elective colectomy compared with nonoperative treatment were younger age of the patient, fewer comorbidities, and percutaneous abscess drainage. Mean follow-up was 8.9 years, with a maximum of 12 years. After nonoperative treatment, 314 patients (13.3%) recurred-222 patients had a single recurrence and 92 patients had a rerecurrence. After adjusting for other variables, older age (hazard ratio, >/=50 years vs <50 years = 0.68; 95% confidence interval, 0.53-0.87) was associated with a lower recurrence, whereas higher comorbidity was associated with higher recurrence. Gender and percutaneous abscess drainage had no influence on recurrence. All 92 rerecurrences were treated nonoperatively. The risk of a rerecurrence (29.3%) was significantly higher than a first recurrence (P<.001). Age, gender, Charlson comorbidity index, and percutaneous abscess drainage did not predict rerecurrence.
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Very few patients with acute diverticulitis treated nonoperatively have recurrence. Younger age was associated with recurrence. A first recurrence was the only factor that predicted rerecurrences. The low recurrence rate argues against routine elective colectomy after successful nonoperative management of acute diverticulitis. Final Decision: no