LAUSR

The authors conducted a retrospective analysis of the New York State Planning and Research Cooperative System database, for 1985 to 2006, evaluating the natural history of acute diverticulitis in patients admitted to hospitals in New York. From this, the authors sought to identify risk factors for recurrent admissions and poor outcomes that may ultimately justify elective surgery. There has been controversy over whether patients who have successfully recovered from an acute diverticulitis episode should undergo elective surgery to prevent future episodes that may lead to the need for emergent surgery and ultimately complications. Some studies show that even patients suffering from diverticulitis complicated by the presence of extraluminal air and/or abscess (considered “complicated” diverticulitis) can be managed conservatively. This study took into consideration 237,879 patients who were admitted to the hospital with a first bout of acute diverticulitis. When analyzing the data, poor outcome was defined as “complicated disease, emergency surgery with or without colostomy, or mortality in any recurrent admission.”Only considering mortality on a recurrent admission leaves room for bias in how the study was conducted. Specifically, this design setup leaves room for survival bias since the patients who died in the hospital on the initial admission being analyzed may have had worse outcomes in the future had they survived. Thus, this study only took into consideration the probability of poor outcomes for patients who were relatively the healthiest and able to survive the analyzed hospital admission. If the patients who had died during the admission been included, it is likely that they would have had further poor outcomes to add to the data and may have changed the statistical significance of the results. According to the study, during an episode of acute diverticulitis, the formation of an abscess and onset at a younger age are two of the most predictive factors for bad outcomes and thus possible reasoning for elective surgery after recovery. Interestingly, some studies show that young patients, when compared with elderly patients, should not be treated more aggressively nor have a lower threshold for elective surgery simply because of their age since they have the same proportion of complicated diverticulitis at presentation as their elderly counterparts. Although this article did an outstanding job of gathering all of the data and organizing it appropriately, it should be recommended that their analysis of poor outcomes takes into account mortality during the current or any future hospital admission since evaluating the data in this manner will provide more statistically valid results regarding this important topic. Ultimately, there is still much controversy, even internationally, regarding the management of acute diverticulitis; many topics, including antibiotic treatment, still have no consensus among experts; however, consensus