EP212 - A Retrospective Evaluation Of Surgical Resection Vs Peritoneal Lavage For Hinchey Class III Diverticulitis

Monday, May 12, 2025

8:10 AM – 8:15 AM PT

Location: Monitor 1, Sails Pavilion, Upper Level

ePoster Presenter(s)

RO

Roberta L. Oslin, MD, MPH

General Surgery Resident PGY3
University of Miami - Palm Beach Consortium , HCA Florida JFK Hospital
Delray Beach, Florida, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

DG

Daniel J. Garcia, MD

Surgical Resident
Umiami
Fort Lauderdale, Florida, United States

Disclosure information not submitted.
Tammy F. Luan, MD

General Surgery Resident
University of Miami Palm Beach Regional Campus
University of Miami Palm Beach Regional Campus
Lantana, Florida, United States

Disclosure information not submitted.
MG

Martin Gutman, M.D.

Resident Physician
University of Miami/HCA JFK Hospital
University of Miami
Boca Raton, Florida, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
SY

Sina Yadegarynia, MD, MS

General Surgery Resident
University of Miami/JFK Medical Center
Lake Worth, Florida, United States

Disclosure information not submitted.
WC

Walter Cisneros, MD

Resident physician
UM/HCA JFK Hospital
Lantana, Florida, United States

Disclosure information not submitted.
HB

Heidi Bahna, MD

Colorectal Surgeon/PD
HCA/ university of Miami
Atlantis, Florida, United States

Disclosure information not submitted.

Senior Author(s)

JR

Juliet Ray, MD

Colorectal Surgeon
HCA
Atlantis, Florida, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Roberta L. Oslin, MD, MPH: This individual has no financial relationships with ineligible companies.

Martin Gutman, M.D.: This individual has no financial relationships with ineligible companies.

Juliet Ray, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Traditional surgical management of Hinchey Class III diverticulitis is resection. Previous randomized clinical trials suggest that laparoscopic peritoneal lavage may be an effective alternative to resection for some patients. However, quality of evidence is low due to variation in inclusion criteria and endpoints between trials, and the safety and efficacy of lavage has not been conclusively established.

Methods/Interventions: We performed a multicenter, retrospective review using a national inpatient database. It included all patients (>18 years old), who underwent surgery for Hinchey Class III diverticulitis between 2016-2023. Univariate analysis compared resection vs non-resection with primary outcomes of length of surgery, length of stay, readmission rate and mortality. Multivariate regression was used to identify independent predictors of readmission and mortality.

Results/Outcomes: 4,152 cases with Hinchey III diverticulitis were identified. Resection was performed in 3,426 (82.5%) and lavage in 726 (17.5%) of patients. Compared to the resection group, patients treated with lavage were older (mean 60.3 vs 58.8 y), more likely to be female (57% vs 52%) and have diagnosis of diabetes (21% vs 16%), and had higher comorbidity and systemic disease scores. Rate of readmission for the index disease case was higher for patients with lavage (9.8% vs 3.1% with resection, p< 0.001). Disease-related mortality was not significantly different between surgery groups (1.8% and 2.2% with lavage and resection, respectively, p=0.488). Duration of surgery and total hospital billed charges were significantly lower in the lavage group compared with resection, while length of hospital stay was not significantly different between groups. In univariable analysis, factors associated with readmission included diabetes, tobacco use, higher ASA physical status, and lavage. In multivariable analysis with these factors, lavage was associated with 3.33 times higher odds of readmission compared with resection. Surgery type was not associated with odds of death in univariable or multivariable analysis.

Conclusion/Discussion: In this large retrospective dataset, peritoneal lavage was independently associated with increased likelihood of readmission but not with a higher mortality rate. Cost of care was lower in the lavage group, even after accounting for readmissions. Patients with comorbidities and poorer systemic health were more commonly treated with lavage compared with resection, which may reflect risk assessment patterns among treating physicians. Additional studies are needed to define which patients are candidates for peritoneal lavage as an alternative to resection.