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Surgeon not patient disease determines the operation for acute complicated diverticulitis
*Mohammad S Jafferji, Neil H Hyman
University of Vermont, Burlington, VT

Objective: The “best’ operation in the setting of acute complicated diverticulitis has been debated for decades. Multiple studies, including a recent prospective randomized trial, have demonstrated improved outcomes with primary anastomosis. The objective is to determine whether surgeon training and background or patient specific factors drive the choice of operative procedures.
Design: Retrospective review of a prospective database
Setting: Academic Medical Center
Patients: Consecutive adult patients with sigmoid diverticulitis requiring operative treatment during an index admission with acute complicated diverticulitis from 1997-2012.
Interventions: Hartmann procedure (HP) or primary anastomosis(PA), with or without loop ileostomy
Main outcome measures: Choice of operation, postop complications, stoma reversal
Results: 151 patients underwent urgent resection and 136 met study criteria. 88 cases (64.7%) were performed by general surgeons and 48 by colorectal surgeons (35.3%)-see table. General surgeons performed more HP (64% vs 29%, p=.01) despite similar demographics, ASA classification and Hinchey stage. Postop complications were lower in the colorectal group (43.2% vs 16.7, p=.02).
Conclusions: Surgeon training rather than degree of sepsis, patient comorbidities or demographics is the primary driver of choice of operative procedure. Our data suggests that a more aggressive approach to primary resection with anastomosis may lower the complication rate after surgical treatment of severe acute diverticulitis.
Table 1. Study Population Characteristics
CharacteristicsGeneral and Other SurgeonsColorectal SurgeonsP-value
Median Age_yrs61560.32
Female (%)36.4500.07
Median Body Mass Index 27.827.60.62
Hinchey Class (Median)
I, n 24
II, n2212
III, n3624
IV, n288
Operation, n8848
Hartmann Procedure, n (%)56 (64.0)18 (38.0)0.012
Primary Anastomosis, n (%)6 (7.0)14 (29.0)0.029
Primary Anastomosis w/ diverting ileostomy, n(%)20 (23)12 (25.0)0.80
Abdominal Washout, n (%)6 (7.0)4 (8.0)
Median Length of Stay, days8.570.86
Median ASA Class 330.93
Stoma Reversal, (%) 61.468.20.24
ICU Admission, (%)20.500.029
Re-intervention, (%)
Median Length of Operations (mins)1811690.63
Stoma Reversal, (%)61.468.20.24
Stoma Reversal, days12492
Complications (SATS)
Intra-operative, n (%)2 (2.3)0 (0)0.43
Post-operative, n (%)38 (43.2)8 (16.7)0.021

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