A. A. Radwan1, S. Wei1, K. M. Mueck1, 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: There is no accepted grading system for comparing the risks between non-operative and operative management of surgical diseases. Recently, the Clavien-Dindo score for grading post-operative complications after elective surgery was modified and validated in hospitalized trauma patients who received non-operative and operative management. We hypothesized that this Adapted Clavien-Dindo in Trauma (ACDiT) scale can be used to grade and compare complications in acute diverticulitis patients across management strategies.
Methods: We performed a retrospective cohort study of patients hospitalized for acute diverticulitis between 2011 – 2016 at a safety-net hospital. Baseline demographics and hospitalization data were collected. ACDiT grades were assigned to all patients. Grades ranged from 0 to 5b; a grade of 0 means no deviation from initial management plan, while a grade of 5b means hospital death despite active treatment. Univariate analysis was performed to compare baseline demographics in non-operatively versus operatively managed patients. ANOVA was used to determine differences in hospital-free days (HFD) based on ACDiT grades. HFD is defined as the number of days spent outside of any healthcare facility within 30 days of the initial admission. Linear regression was performed to assess correlation between ACDiT grades with HFD.
Results: There were a total of 260 patients, of which 177 (68%) were non-operatively and 83 (32%) were operatively managed. There were no differences in age, sex, race, Charleston Co-morbidity Index, or intraabdominal drain placement based on management strategy (p > 0.05). Eighty-five (33%) patients developed a complication, of which 78 (92%) complications received ACDiT grades 1 – 3b. There were no patients with ACDiT grade 5. Higher ACDiT grades correlated inversely with less HFD (r = -0.77, p < 0.0001), in the entire cohort (Figure) and individually for non-operative (r = -0.79, p <0.0001) and operative (r = -0.71, p <0.0001) management.
Conclusion: The ACDiT grading system can be used for classifying the severity of complications in hospitalized diverticulitis patients managed non-operatively and operatively and correlates with hospital-free days. ACDiT is a promising tool for weighing the risks of non-operative and operative management.
