TY - JOUR
T1 - Observational versus antibiotic treatment for uncomplicated diverticulitis: an individual-patient data meta-analysis
AU - van Dijk, S. T.
AU - Chabok, A.
AU - Dijkgraaf, M. G.
AU - Boermeester, M. A.
AU - Smedh, K.
N1 - Funding Information: The AVOD trial was funded by the Uppsala and ?rebro Regional Research Foundation. The DIABOLO trial was funded by the Netherlands Organization for Health Research and Development (ZonMw; 171002303), and Digestive Diseases Foundation (Maag Lever Darm Stichting, MLDS WO08-54). The funding sources had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. Disclosure: The authors declare no conflict of interest. Funding Information: The AVOD trial was funded by the Uppsala and Örebro Regional Research Foundation. The DIABOLO trial was funded by the Netherlands Organization for Health Research and Development (ZonMw; 171002303), and Digestive Diseases Foundation (Maag Lever Darm Stichting, MLDS WO08‐54). The funding sources had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. Publisher Copyright: © 2020 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Background: Two RCTs (AVOD and DIABOLO) demonstrated no difference in recovery or adverse outcomes when antibiotics for acute uncomplicated diverticulitis were omitted. Both trials showed non-significantly higher rates of complicated diverticulitis and surgery in the non-antibiotic groups. This meta-analysis of individual-patient data aimed to explore adverse outcomes and identify patients at risk who may benefit from antibiotic treatment. Methods: Individual-patient data from those with uncomplicated diverticulitis from two RCTs were pooled. Risk factors for adverse outcomes and the effect of observational management were assessed using logistic regression analyses. P < 0·025 was considered statistically significant owing to multiple testing adjustment. Results: In total, 545 patients in the observational group and 564 in the antibiotics group were included. No statistical differences were found in 1-year follow-up rates of ongoing diverticulitis (7·2 versus 5·0 per cent in observation versus antibiotics groups respectively; P = 0·062), recurrent diverticulitis (8·6 versus 9·6 per cent; P = 0·610), complicated diverticulitis (4·0 versus 2·1 per cent; P = 0·079) and sigmoid resection (5·0 versus 2·5 per cent; P = 0·214). An initial pain score greater than 7, white blood cell count exceeding 13·5 × 10 9/l and previous diverticulitis at presentation were risk factors for adverse outcomes. Antibiotic treatment did not prevent adverse outcomes in patients at high risk of adverse events. Conclusion: Observational management of acute uncomplicated diverticulitis is safe. Some statistical uncertainty remains, depending on the thresholds of clinical relevance, owing to small differences, but no subgroup that would benefit from antibiotic treatment was apparent.
AB - Background: Two RCTs (AVOD and DIABOLO) demonstrated no difference in recovery or adverse outcomes when antibiotics for acute uncomplicated diverticulitis were omitted. Both trials showed non-significantly higher rates of complicated diverticulitis and surgery in the non-antibiotic groups. This meta-analysis of individual-patient data aimed to explore adverse outcomes and identify patients at risk who may benefit from antibiotic treatment. Methods: Individual-patient data from those with uncomplicated diverticulitis from two RCTs were pooled. Risk factors for adverse outcomes and the effect of observational management were assessed using logistic regression analyses. P < 0·025 was considered statistically significant owing to multiple testing adjustment. Results: In total, 545 patients in the observational group and 564 in the antibiotics group were included. No statistical differences were found in 1-year follow-up rates of ongoing diverticulitis (7·2 versus 5·0 per cent in observation versus antibiotics groups respectively; P = 0·062), recurrent diverticulitis (8·6 versus 9·6 per cent; P = 0·610), complicated diverticulitis (4·0 versus 2·1 per cent; P = 0·079) and sigmoid resection (5·0 versus 2·5 per cent; P = 0·214). An initial pain score greater than 7, white blood cell count exceeding 13·5 × 10 9/l and previous diverticulitis at presentation were risk factors for adverse outcomes. Antibiotic treatment did not prevent adverse outcomes in patients at high risk of adverse events. Conclusion: Observational management of acute uncomplicated diverticulitis is safe. Some statistical uncertainty remains, depending on the thresholds of clinical relevance, owing to small differences, but no subgroup that would benefit from antibiotic treatment was apparent.
UR - http://www.scopus.com/inward/record.url?scp=85079840744&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/bjs.11465
DO - https://doi.org/10.1002/bjs.11465
M3 - Article
C2 - 32073652
SN - 0007-1323
VL - 107
SP - 1062
EP - 1069
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 8
ER -