Long-term survival after perforated diverticulitis

被引:10
作者
Vermeulen, J. [1 ]
Gosselink, M. P. [2 ]
Hop, W. C. J. [3 ]
van der Harst, E. [2 ]
Hansen, B. E. [3 ]
Mannaerts, G. H. H. [4 ]
Coene, P-P. L. O. [2 ]
Weidema, W. F. [5 ]
Lange, J. F. [1 ]
机构
[1] Erasmus MC, Dept Surg Rotterdam, Rotterdam, Netherlands
[2] Maasstad Hosp, Dept Surg, Rotterdam, Netherlands
[3] Erasmus MC, Dept Biostat, Rotterdam, Netherlands
[4] Hosp St Franciscus Gasthuis, Dept Surg, Rotterdam, Netherlands
[5] Ikazia Hosp, Dept Surg, Rotterdam, Netherlands
关键词
perforated diverticulitis; Harmann's procedure; primary anastomosis; long-term survival; SIGMOID DIVERTICULITIS; HARTMANNS PROCEDURE; PERITONITIS; RESECTION; SURGERY; MULTICENTER; MORBIDITY; PROGNOSIS; DISEASE; STOMA;
D O I
10.1111/j.1463-1318.2009.02112.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Aim Short-term survival after emergency surgery for perforated diverticulitis is poor. Less is known about long-term survival. The aims of this study were to evaluate long-term survival after discharge from hospital and to identify factors associated with prognosis. Method All patients who underwent emergency surgery for perforated diverticulitis in five hospitals in Rotterdam, the Netherlands, between 1990 and 2005, were included. The association between type of surgery (Hartmann's procedure or primary anastomosis) and long-term survival was analysed using multivariate Cox regression analysis, taking into account age American Society of Anesthesiology (ASA) classification, Hinchey score, Mannheim Peritonitis Index (MPI) and surgeon's experience. In addition, survival of the patients was compared with that of the matched general Dutch population. Results Of 340 patients included in the study, 250 were discharged alive from hospital. The overall 5-year survival was 53%. Survival was significantly impaired compared with the expected matched gender-, age- and calendar time-specific survival. Overall survival was significantly related to age and ASA classification. Hinchey score, MPI, number of re-interventions, the surgeon's experience and type of procedure did not influence long-term survival, although a trend was found for Hartmann's procedure to be a risk factor for poorer survival compared with primary anastomosis (hazard ratio for mortality: 1.88; 95% confidence interval, 0.96-3.67; P = 0.07). Conclusion Long-term survival of patients after perforated diverticulitis is limited and mainly caused by the poor general condition of the patients, rather than by the severity of the primary disease or calendar-time and type of procedure.
引用
收藏
页码:203 / 209
页数:7
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