Conditional risk of diverticulitis after non-operative management
1. Among patients managed without surgery, the conditional recurrence-free survival of diverticulitis increased with each year survived recurrence-free.
2. Lower age and higher comorbidity burden were both associated with an increased risk of recurrence.
Evidence Level Rating: 2 (Good)
Sigmoid diverticulitis is a very common gastrointestinal condition, and although the rate of occurrence is increasing in the U.S., the rate of emergent surgery as a means of treatment is decreasing. Recurrence of diverticulitis is one of the most important determinants of surgery; as such, a robust understanding of future risk is important for navigating surgical decision making. This retrospective cohort study involving 991 (median [IQR] age = 62 [50-73] years, 45.7% male) patients evaluated the conditional recurrence-free survival (RFS) after an initial episode of diverticulitis managed without surgery. Conditional RFS accounts for the dynamic nature of risk and does not assume that risk is static throughout the follow-up period. Among patients experiencing recurrence of diverticulitis, 76.7% occurred within the first two years of follow-up, and 53.1% occurred within the first year. It was found that one-year conditional RFS increased with each additional year survived recurrence-free, exceeding 95% for all subsequent years after surviving the first four years recurrence-free. Furthermore, at two years after the initial episode, lower age (HR 0.98, 95% CI 0.96 to 0.99) and Charlson Comorbidity Index (CCI) score of ≥ 2 (HR 2.41, 95% CI 1.30 to 4.46) were found to be associated with recurrence. While initially associated with recurrence at the time of the initial episode, immunosuppression was no longer associated with recurrence after two years (HR 1.02, 95% CI 0.50 to 2.09). In all, this study showed that conditional RFS of diverticulitis improved with each year survived recurrence free and identified specific risk factors associated with recurrence. These data have practical implications for clinical decision making; it can inform patients of their own risk of recurrence and aid in the process of shared decision making with regards to elective surgery for recurrent diverticulitis.
Click to read the study in BJSS
Image: PD
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