Acute Diverticulitis, Complicated Diverticulitis, Perforated Diverticulitis, Peritonitis
Conditions
Keywords
Perforated diverticulitis, Emergency surgery, Non-elective surgery, Primary anastomosis, Hartmann's procedure, Intraoperative decision-making, Artificial intelligence, Computer vision, Surgical video analysis, Multimodal dataset
Brief summary
The AIDE/OBS study is a multicenter, observational, non-interventional study designed to collect standardized clinical, radiological, intraoperative visual, and surgical reasoning data from adult patients undergoing non-elective surgery for complicated acute diverticulitis. The study focuses on patients requiring urgent or emergency operative management, including cases following failure of non-operative management. The main intraoperative decision of interest is the choice between sigmoid resection with primary anastomosis, with or without diverting stoma, and Hartmann's procedure. The current phase aims to build a structured multimodal dataset and to validate and refine a preliminary expert-informed decision-support tool. The study does not modify standard clinical practice, surgical indication, operative strategy, or postoperative management. All treatment decisions remain at the discretion of the treating surgical team according to local practice.
Detailed description
Complicated acute diverticulitis requiring non-elective surgery remains a challenging condition in emergency colorectal surgery. In patients with diffuse peritonitis or severe complicated disease, the intraoperative decision between primary anastomosis and Hartmann's procedure is complex and influenced by patient-related factors, disease severity, contamination, tissue quality, bowel perfusion, technical feasibility, and surgeon judgment. The AIDE/OBS study aims to collect retrospectively and prospectively standardized real-world data from multiple centers to better understand the factors influencing this decision. The study will collect clinical and demographic characteristics, comorbidities, radiological findings including WSES CT-driven classification, intraoperative findings, operative strategy, postoperative outcomes, anonymized intraoperative images or videos when available, and surgeon-reported decision-making factors. The collected data will be used to validate and refine a preliminary expert-informed AI-based decision-support framework. The long-term objective is to support the development of future artificial intelligence and computer vision tools that may assist emergency surgeons during intraoperative decision-making in complicated diverticulitis. This is an observational, non-interventional study. No experimental treatment, device, or AI-guided recommendation is applied to patients during the study. Surgical management is performed according to standard clinical practice and local protocols.
Interventions
PROCEDUREPrimary anastomosis
Observed surgical strategy consisting of sigmoid resection with colorectal anastomosis, with or without diverting stoma, performed according to standard clinical practice. The study does not assign this procedure.
PROCEDUREHartmann's procedure
Observed surgical strategy consisting of sigmoid resection with end colostomy and rectal stump closure, performed according to standard clinical practice. The study does not assign this procedure.
Sponsors
IRCCS San Raffaele Roma
Study design
Observational model
COHORT
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older * Diagnosis of acute complicated diverticulitis requiring non-elective operative management * Emergency or urgent surgery for complicated diverticulitis, including surgery after failure of non-operative management * Minimally invasive approach: laparoscopic/robotic surgery * Patients undergoing sigmoid resection with primary anastomosis, Hartmann's procedure, or other operative strategy according to local practice * Availability of clinical and operative data * Local ethical approval, authorization, or waiver according to national and institutional regulations
Exclusion criteria
* Age younger than 18 years * Elective surgery for diverticular disease * Uncomplicated diverticulitis managed non-operatively * Surgery performed for conditions not related to diverticulitis * Surgical procedures performed via primary open approach (i.e., no attempt at minimally invasive surgery), unless converted intraoperatively. * Lack of required consent or authorization for data use, when required by local regulations
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical, radiological, intraoperative visual, and surgeon-reported factors associated with the intraoperative decision to perform primary anastomosis versus Hartmann's procedure | Assessed intraoperatively during the index emergency surgical procedure and recorded at completion of operative case data entry. | Structured analysis of patient-related, disease-related, imaging-related, intraoperative, and surgeon-reported factors influencing the choice between primary anastomosis and Hartmann's procedure in non-elective surgery for complicated diverticulitis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of primary anastomosis versus Hartmann's procedure | Assessed intraoperatively during the index emergency surgical procedure. | Proportion of patients undergoing primary anastomosis, with or without diverting stoma, compared with Hartmann's procedure. |
| Completeness of standardized intraoperative visual data acquisition | From the start of the index emergency surgical procedure until completion of intraoperative image or video acquisition, assessed up to the end of the operation. | Proportion of cases with uploaded anonymized intraoperative images or videos according to the predefined study phases. |
| Anastomotic leak rate | From the date of surgery until 30 postoperative days. | Rate of clinically or radiologically diagnosed anastomotic leak among patients receiving primary anastomosis. |
| Postoperative morbidity | Assessed during index hospitalization and up to 30 postoperative days. | Rate of postoperative complications after non-elective surgery for complicated diverticulitis. |
| Stoma creation rate | Assessed intraoperatively during the index emergency surgical procedure. | Proportion of patients receiving a stoma during the index operation. |
| Length of hospital stay | From the date of the index emergency surgical procedure until hospital discharge, assessed up to 90 days. | Duration of hospital stay after the index operation. |
| Mortality | From the date of surgery up to 30 postoperative days. | All-cause postoperative mortality |
| Proportion of enrolled cases with complete standardized clinical and intraoperative visual datasets | From study initiation until completion of participant enrollment and database closure, estimated up to 24 months. | Feasibility will be assessed as the proportion of enrolled patients for whom the participating center successfully submits a complete standardized dataset, including required clinical variables, radiological classification, intraoperative decision-making form, and standardized intraoperative visual material according to the study protocol. A complete visual dataset will be defined as submission of the required intraoperative images or video frames for the predefined operative phases, when technically feasible. |
Countries
Italy
Contacts
CONTACTBelinda De Simone, MD
Outcome results
None listed