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Tartaglia D, Cremonini C, Annunziata E, Catena F, Sartelli M, Kirkpatrick AW, Musetti S, Strambi S, Chiarugi M, Coccolini F. Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T). Tech Coloproctol 2023; 27:747-757. [PMID: 36749438 PMCID: PMC10404182 DOI: 10.1007/s10151-023-02758-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. METHODS We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). RESULTS Data from 482 patients were analyzed-229 patients (47.5%) [M:F = 1:1; median age: 60 (24-95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26-94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p < 0.00001). In group A, severe sepsis (p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann's procedure is mainly performed in grades 1-2 (p < 0.0001). Major complications increased significantly after a Hartmann's procedure (p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002). CONCLUSIONS Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann's procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also require a longer hospital stay.
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Affiliation(s)
- Dario Tartaglia
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy.
| | - Camilla Cremonini
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
| | - Elena Annunziata
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
| | - Fausto Catena
- Department of Surgery, Bufalini" Hospital, Cesena, Italy
| | | | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Canada
| | - Serena Musetti
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
| | - Silvia Strambi
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
| | - Massimo Chiarugi
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
| | - Federico Coccolini
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
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