Damage control surgery in perforated diverticulitis reduces the stoma rate: A multicentre international retrospective cohort study.

Abstract

Perforated diverticulitis of the left colon with peritonitis remains life-threatening. However, the optimal surgical strategy is still under debate. The presented study compares the impact of a routinely applied two-stage damage control strategy (DCS) in perforated purulent or faeculent diverticulitis with currently used non-DCS strategies. This international multicentre retrospective cohort study was conducted in nine European hospitals. In five hospitals, the therapeutic algorithm covered the routine application of a two-stage DCS as a surgical standard for treating perforated diverticulitis. Four hospitals performed conventional one-stage surgeries and served as controls. The primary outcome was stoma rate at the end of the initial hospital stay. The key secondary outcomes were morbidity and mortality rates. Overall, data from 558 patients were included, 365 of whom were from DCS centres with equally distributed sex. Patients treated in DCS centres were significantly younger (67 ± 14 vs. 70 ± 14, p = 0.007) but showed a higher Mannheim peritonitis index (22.3 ± 7.9 vs. 20.4 ± 8.0, p = 0.008). At discharge, patients treated in DCS hospitals had a significantly lower stoma rate (stoma-free: DCS, 45.6% vs. non-DCS, 20.8%; p = 0.001). Secondary outcome parameters showed no differences between the investigated cohorts, in addition to significantly longer ICU stays (7.28 ± 11.13 vs. 5.15 ± 9.60 days; p < 0.001) and an increased number of surgical interventions during the hospital stay in DCS centres (2.64 ± 1.89 vs. 1.51 ± 1.10; p < 0.001). Patients treated in DCS hospitals for perforated diverticulitis are significantly more likely to be discharged without a stoma than patients treated in hospitals using the current standard treatment.