Background

To evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis.

Methods

A systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis. Emergency and elective surgical resections, development of complicated diverticulitis, mortality rate, and length of hospital stay were the other evaluated secondary outcome parameters.

Results

The literature search identified twelve studies (n = 3,875) comparing NABX (n = 2,008) versus ABX (n = 1,867). The NABX group showed a lower disease recurrence rate and shorter length of hospital stay compared with the ABX group (P = 0.01) and (P = 0.004). No significant difference was observed in emergency resections (P = 0.33), elective resections (P = 0.73), development of complicated diverticulitis (P = 0.65), hospital re-admissions (P = 0.65) and 30-day mortality rate (P = 0.91). Twelve studies (n = 2,286) compared OP (n = 1,021) versus IP (n = 1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P = 0.10), emergency surgical resection (P = 0.40), elective resection (P = 0.30), disease recurrence (P = 0.22), and mortality rate (P = 0.61).

Conclusion

Observation-only treatment is feasible and safe in selected clinically stable patients with uncomplicated acute diverticulitis (Hinchey 1a classification). It may provide better outcomes including decreased length of hospital stay. Moreover, the OP approach in treating patients with Hinchey 1a acute diverticulitis is comparable to IP management. Future high-quality randomised controlled studies are needed to understand the outcomes of the NABX approach used in an OP setting in managing patients with uncomplicated acute diverticulitis.

中文翻译：

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急性单纯性憩室炎治疗的系统回顾和荟萃分析：是时候改变传统做法了

背景

旨在评估门诊 (OP) 与住院 (IP) 治疗以及抗生素 (ABX) 与不使用抗生素 (NABX) 方法治疗无并发症（Hinchey 1a 级）急性憩室炎的比较结果。

方法

使用电子数据库进行系统的在线搜索。 OP 与 IP 治疗以及 ABX 与 NABX 方法治疗 Hinchey 1a 级急性憩室炎的比较研究也纳入其中。主要结局是憩室炎复发。紧急和择期手术切除、复杂性憩室炎的发生、死亡率和住院时间是其他评估的次要结果参数。

结果

文献检索确定了 12 项研究 ( n  = 3,875)，比较了 NABX ( n  = 2,008) 与 ABX ( n  = 1,867)。与ABX组相比，NABX组的疾病复发率较低（ P  =0.01），住院时间较短（ P  =0.004）。急诊切除（P  = 0.33）、择期切除（P  = 0.73）、复杂性憩室炎（P  = 0.65）、再次入院（P  = 0.65）和30天死亡率（P  = 0.91）。 12 项研究 ( n  = 2,286) 比较了 OP ( n  = 1,021) 与 IP ( n  = 1,265) 对无并发症急性憩室炎的治疗。两组在以下结局方面具有可比性：治疗失败（P  =0.10）、紧急手术切除（P  =0.40）、择期切除（P  =0.30）、疾病复发（P  =0.22）和死亡率（P  =0.61 ） ）。

结论

对于选定的临床稳定的无并发症急性憩室炎（Hinchey 1a 分类）患者，仅观察治疗是可行且安全的。它可以提供更好的结果，包括缩短住院时间。此外，治疗 Hinchey 1a 急性憩室炎患者的 OP 方法与 IP 治疗相当。未来需要进行高质量的随机对照研究，以了解在 OP 环境中使用 NABX 方法治疗无并发症的急性憩室炎患者的结果。