Operative management of colonic diverticular disease in the setting of immunosuppression: A systematic review and meta-analysis

Tyler McKechnie; Yung Lee; Colin Kruse; Yuan Qiu; Jeremy E Springer; Aristithes G Doumouras; Dennis Hong; Cagla Eskicioglu

doi:10.1016/j.amjsurg.2020.06.035

Operative management of colonic diverticular disease in the setting of immunosuppression: A systematic review and meta-analysis

Am J Surg. 2021 Jan;221(1):72-85. doi: 10.1016/j.amjsurg.2020.06.035. Epub 2020 Jul 8.

Authors

Tyler McKechnie¹, Yung Lee², Colin Kruse³, Yuan Qiu⁴, Jeremy E Springer⁵, Aristithes G Doumouras⁶, Dennis Hong⁷, Cagla Eskicioglu⁸

Affiliations

¹ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: [email protected].
² Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: [email protected].
³ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. Electronic address: [email protected].
⁴ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. Electronic address: [email protected].
⁵ Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: [email protected].
⁶ Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada. Electronic address: [email protected].
⁷ Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada. Electronic address: [email protected].
⁸ Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada. Electronic address: [email protected].

PMID: 32814626
DOI: 10.1016/j.amjsurg.2020.06.035

Abstract

Background: Immunosuppressed patients with diverticular disease are at higher risk of postoperative complications, however reported rates have varied. The aim of this study is to compare postoperative outcomes in immunosuppressed and immunocompetent patients undergoing surgery for diverticular disease.

Methods: Medline, EMBASE, and CENTRAL were searched. Articles were included if they compared immunosuppressed and immunocompetent patients undergoing surgery for diverticular disease.

Results: From 204 citations, 11 studies with 2,977 immunosuppressed patients and 780,630 immunocompetent patients were included. Mortality was greater in immunosuppressed patients compared to immunocompetent patients for emergent surgery (RR 1.91, 95%CI 1.24-2.95, p < 0.01), but not elective surgery (RR 1.70, 95%CI 0.14-20.47, p = 0.68). Morbidity was greater in immunosuppressed patients compared to immunocompetent patients for elective surgery (RR 2.18, 95%CI 1.02-4.65, p = 0.04), but not emergent surgery (RR 1.40, 95%CI 0.68-2.90, p = 0.37).

Conclusions: Increased consideration for elective operation may preclude the need for emergent surgery and the associated increase in postoperative mortality.

Keywords: Colonic diverticular disease; Colonic diverticulitis; Elective surgery; Emergent surgery; Immunosuppression.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Diverticulitis, Colonic / surgery*
Humans
Immunosuppression Therapy*
Treatment Outcome