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Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment.
Ann Surg 2009; 249(2):210-7AnnS

Abstract

OBJECTIVES

Diverticular disease imposes an impressive clinical burden to the United States population, with over 300,000 admissions and 1.5 million days of inpatient care annually. Consensus regarding the treatment of diverticulitis has evolved over time, with increasing advocacy of primary anastomosis for acute diverticulitis, and nonoperative treatment of recurrent mild/moderate diverticulitis. We analyzed whether these changes are reflected in patterns of practice in a nationally-representative patient cohort.

METHODS

We used the 1998 to 2005 nationwide inpatient sample to analyze the care received by 267,000 patients admitted with acute diverticulitis, and 33,500 patients operated electively for diverticulitis. Census data were used to calculate population-based incidence rates of disease and surgical treatment. Weighted logistic regression with cluster adjustment at the hospital level was used for hypothesis testing.

RESULTS

Overall annual age-adjusted admissions for acute diverticulitis increased from 120,500 in 1998 to 151,900 in 2005 (26% increase). Rates of admission increased more rapidly within patients aged 18 to 44 years (82%) and 45 to 74 years (36%). Elective operations for diverticulitis rose from 16,100 to 22,500 per year during the same time period (29%), also with a more rapid increase (73%) in rates of surgery for individuals aged 18 to 44 years. Multivariate analysis found no evidence that primary anastomosis is becoming more commonly used.

CONCLUSIONS

We are the first to report dramatic changes in rates of treatment for diverticulitis in the United States. The causes of this emerging disease pattern are unknown, but certainly deserve further investigation. For patients undergoing surgery for acute diverticulitis, there was little change over time in the likelihood of a primary anastomosis.

Authors+Show Affiliations

Departments of Colorectal Surgery, University of Southern California, Los Angeles, 90033, USA. etzioni.david@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19212172

Citation

Etzioni, David A., et al. "Diverticulitis in the United States: 1998-2005: Changing Patterns of Disease and Treatment." Annals of Surgery, vol. 249, no. 2, 2009, pp. 210-7.
Etzioni DA, Mack TM, Beart RW, et al. Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg. 2009;249(2):210-7.
Etzioni, D. A., Mack, T. M., Beart, R. W., & Kaiser, A. M. (2009). Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Annals of Surgery, 249(2), pp. 210-7. doi:10.1097/SLA.0b013e3181952888.
Etzioni DA, et al. Diverticulitis in the United States: 1998-2005: Changing Patterns of Disease and Treatment. Ann Surg. 2009;249(2):210-7. PubMed PMID: 19212172.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. AU - Etzioni,David A, AU - Mack,Thomas M, AU - Beart,Robert W,Jr AU - Kaiser,Andreas M, PY - 2009/2/13/entrez PY - 2009/2/13/pubmed PY - 2009/3/6/medline SP - 210 EP - 7 JF - Annals of surgery JO - Ann. Surg. VL - 249 IS - 2 N2 - OBJECTIVES: Diverticular disease imposes an impressive clinical burden to the United States population, with over 300,000 admissions and 1.5 million days of inpatient care annually. Consensus regarding the treatment of diverticulitis has evolved over time, with increasing advocacy of primary anastomosis for acute diverticulitis, and nonoperative treatment of recurrent mild/moderate diverticulitis. We analyzed whether these changes are reflected in patterns of practice in a nationally-representative patient cohort. METHODS: We used the 1998 to 2005 nationwide inpatient sample to analyze the care received by 267,000 patients admitted with acute diverticulitis, and 33,500 patients operated electively for diverticulitis. Census data were used to calculate population-based incidence rates of disease and surgical treatment. Weighted logistic regression with cluster adjustment at the hospital level was used for hypothesis testing. RESULTS: Overall annual age-adjusted admissions for acute diverticulitis increased from 120,500 in 1998 to 151,900 in 2005 (26% increase). Rates of admission increased more rapidly within patients aged 18 to 44 years (82%) and 45 to 74 years (36%). Elective operations for diverticulitis rose from 16,100 to 22,500 per year during the same time period (29%), also with a more rapid increase (73%) in rates of surgery for individuals aged 18 to 44 years. Multivariate analysis found no evidence that primary anastomosis is becoming more commonly used. CONCLUSIONS: We are the first to report dramatic changes in rates of treatment for diverticulitis in the United States. The causes of this emerging disease pattern are unknown, but certainly deserve further investigation. For patients undergoing surgery for acute diverticulitis, there was little change over time in the likelihood of a primary anastomosis. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/19212172/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=19212172 DB - PRIME DP - Unbound Medicine ER -