Mortality and complications following surgery for diverticulitis: Systematic review and meta-analysis

• Published in: United European Gastroenterology Journal
• Main Authors: Haas, Jason M, Singh, Maharaj, Vakil, Nimish
• Format: Text
• Language: unknown
• Published: Advocate Aurora Health Institutional Repository 2015
• Subjects: Advocate Aurora Research Institute; Aurora Research Institute
• Online Access: https://institutionalrepository.aah.org/gastro/15; https://doi.org/10.1177/2050640615617357

Background The surgical treatment of diverticulitis is in a state of evolution. Clinicians across many disciplines need to counsel patients regarding surgical choices. Objectives A systematic review and meta-analysis was conducted to determine the mortality and complication rates following surgery for diverticulitis in both the emergent and elective setting. Methods We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles published from 1980 to 2012. The primary outcome of interest was the point estimate of mortality, following surgery for diverticulitis. Results Of the 289 citations reviewed, we included 59 studies. Overall, the point estimate for mortality was 3.05%, with a 95% confidence intereval (CI) of 1.73–5.32 and p < 0.001. Mortality following emergent surgery was 10.64% (95% CI 7.95–14.11;p < 0.001), versus 0.50% (95% CI 0.46–0.54; p < 0.001) following elective operations. A laparoscopic approach had an estimated mortality of 0.75% (95% CI 0.35–1.58; p < 0.001), compared to an open surgical approach, which had a mortality of 4.69% (95% CI 2.29–9.36, p < 0.001). The mortality following a resection with primary anastomosis was 1.96% (95% CI 1.22–3.13; p < 0.001) and for the Hartmann’s procedure was 14.18% (95% CI 9.83–20.03; p < 0.001). A comparative analysis found that the risk of post-operative mortality was significantly higher following emergent surgery, compared to elective surgery (odds ratio (OR): 6.12 with 95% CI 1.62–23.10; p = 0.008; Q = 2.56,p = 0.46 and I2 = 0); the open approach, compared to a laparoscopic approach (OR: 36.43 with 95% CI 9.94–133.6; p = 0.13; and Q = 2.79, p = 0.25 and I2 = 28.26); and for Hartmann’s procedure, compared to primary anastomosis without diversion (OR: 25.45 with 95% CI 15.13–42.81, p < 0.001; and Q = 23.34, p = 0.14 and I2 = 27.16). The overall reported post-operative complication rate was 32.64% (95% CI 27.43–38.32; p < 0.00). The overall surgical and medical complication rates ...