S. Wei1, K. M. Mueck1, A. A. Radwan1, C. Wan1, C. E. Wade1, T. C. Ko1, S. G. Millas1, L. S. Kao1 1McGovern Medical School at UTHealth,Acute Care Surgery,Houston, TX, USA
Introduction: Complications during hospitalization for diverticulitis are difficult to classify using traditional tools such as the Clavien-Dindo system, since only 10% of patients require surgical intervention during the same admission. The Adapted Clavien-Dindo in Trauma (ACDiT) grading system is advantageous over the traditional Clavien-Dindo score because it is applicable to emergent surgeries and to patients managed non-operatively. We have shown that ACDiT is applicable to acute diverticulitis patients, and we aimed to identify factors associated with ACDiT ≥ grade 2 complications in acute diverticulitis patients managed medically or surgically. ACDiT score of 2 means the complication required pharmacologic treatment (not including antiemetics, antipyretics, analgesics, diuretics, and electrolytes) or unexpected blood transfusions, but did not require unplanned procedures or intensive care unit admission.
Methods: We performed a retrospective cohort study of patients hospitalized for acute diverticulitis admitted to surgery between 2011 – 2016 at a safety-net hospital. Baseline demographics and hospitalization data were collected. ACDiT scores were assigned; scores range from 0 to 5b, with 0 indicating no deviation from treatment plan and 5b indicating death despite active treatment. Univariate analysis was performed. Inverse probability weighted (IPW) propensity scores were assigned for surgical management, and IPW regression analysis was used to determine factors associated with ACDiT ≥ grade 2.
Results: Of 260 patients, 177 (68%) were managed medically. There were no differences in age, sex, race, Charleston Co-morbidity Index (CCI), or intraabdominal drain placement based on management strategy. On multivariable analysis, percutaneous drainage was associated with higher odds of ACDiT ≥ grade 2 with medical and surgical management. Higher CCI increased the odds of ACDiT ≥ grade 2 with medical management, while open surgery increased the odds of ACDiT ≥ grade 2 with surgical management. On IPW propensity score analysis, Hinchey 3, percutaneous drainage, and surgical management had 11-, 9-, and 3-times higher odds of having a complication of ACDiT ≥ grade 2 (Table).
Conclusion: The ACDiT score can be used to grade complications in acute diverticulitis patients managed medically or surgically, and to identify factors contributing to worse outcomes regardless of management strategy. Factors associated with ACDiT ≥ grade 2 include Hinchey 3, percutaneous drainage, and surgical management. ACDiT should be considered as a tool that can be used to benchmark outcomes for acute diverticulitis and to compare the effectiveness of strategies addressing risk factors for complications.
