Quality of life after conservative versus surgical treatment of acute complicated diverticulitis. Preliminary results from SCANDIV II
Hannah Sahli, Pamela Buchwald, Johannes Schultz, Johanna Sigurdardottir, Maziar Nikberg, Abbas ChabokAbstract
Introduction
Patient-reported outcomes after acute complicated diverticulitis is poorly described. We evaluated quality of life (QoL) at 30 days and 1-year after conservative versus surgical treatment in the prospective multicenter SCANDIV II cohort.
Methods
This substudy included patients with acute complicated diverticulitis who completed QoL questionnaires at 30 days and/or 1 year. Disease severity was classified by CT-verified Hinchey stage. Treatment was conservative (antibiotics +/− drainage) or surgical (surgery +/− drainage). QoL was assessed using EQ-5D, GIQLI, and Short Health Scale.
Results
At 30 days, 363 (70.9%) responded, including 284 (72.1%) of conservatively- and 79 (66.9%) of surgically treated patients. At 1 year, 354 (69.1%) responded, including 284 (72.1%) of conservatively- and 70 (59.3%) of surgically treated patients. Hinchey 3 was more common in the surgical group (48 versus 16%) and Hinchey 2 in the conservative group (54 versus 22%). Conservative treatment was associated with better early QoL. More patients reported no problems with mobility (87 versus 72%, P = 0.003), self-care (98 versus 89%, P < 0.001) and usual activities (83 versus 59%, P < 0.001). GIQLI total score was higher after conservative treatment (99 versus 91, P = 0.010), and SHS showed worse recovery after surgery for activities (P < 0.001) and total score (P = 0.002). At 1-year, most differences had resolved, although GIQLI physical score remained lower after surgery (13 versus 16, P = 0.001).
Discussion
In acute complicated diverticulitis, surgery was associated with worse early patient-reported recovery than conservative treatment, but most differences had resolved by 1 year. Interpretation should consider greater baseline CT severity in surgically treated patients.