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Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis?
Dis Colon Rectum 2009; 52(9):1558-63DC

Abstract

PURPOSE

Indications for operative intervention in the treatment of diverticulitis have become unclear. We hypothesized that surgical treatment for diverticulitis has decreased resulting in proportionately more complicated diverticulitis cases (free perforation and/or abscess).

METHODS

We conducted a retrospective analysis of patients with diverticular disease in the Nationwide Inpatient Sample from 1991 through 2005. We used diagnostic codes to identify all patient discharges with diverticular disease and then determined the proportion of discharges with diverticulitis, perforated disease, diverticular abscess, and surgical treatment.

RESULTS

During the study period, 685,390 diverticulitis discharges were recorded. The ratio of diverticulitis discharges increased from 5.1 cases per 1,000 inpatients in 1991 to 7.6 cases per 1,000 inpatients in 2005 (P < 0.0001). The proportion of patients who underwent colectomy for uncomplicated diverticulitis declined from 17.9% in 1991 to 13.7% in 2005 (P < 0.0.0001). During the same period, the proportion of free diverticular perforations as a fraction of all diverticulitis cases remained unchanged (1.5%). The proportion of diverticular abscess discharges as a fraction of all diverticulitis cases increased from 5.9% in 1991 to 9.6% in 2005 (P < 0.0001). Last, we noted a decrease in diverticular perforations and/or abscess treated with colectomy, 71.0% in 1991 to 55.5% in 2005 (P < 0.0001).

CONCLUSIONS

Despite a significant decline in surgical treatment for diverticulitis, there has been no change in the proportion of patients discharged for free diverticular perforation. There was an increase in diverticular abscess discharges, but this finding was not associated with an increase in same stay surgical treatment.

Authors+Show Affiliations

Department of Colorectal Surgery, Lahey Clinic, Tufts University Medical School, Burlington, Massachusetts 01805, USA. rocco.ricciardi@lahey.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19690482

Citation

Ricciardi, Rocco, et al. "Is the Decline in the Surgical Treatment for Diverticulitis Associated With an Increase in Complicated Diverticulitis?" Diseases of the Colon and Rectum, vol. 52, no. 9, 2009, pp. 1558-63.
Ricciardi R, Baxter NN, Read TE, et al. Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis? Dis Colon Rectum. 2009;52(9):1558-63.
Ricciardi, R., Baxter, N. N., Read, T. E., Marcello, P. W., Hall, J., & Roberts, P. L. (2009). Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis? Diseases of the Colon and Rectum, 52(9), pp. 1558-63. doi:10.1007/DCR.0b013e3181a90a5b.
Ricciardi R, et al. Is the Decline in the Surgical Treatment for Diverticulitis Associated With an Increase in Complicated Diverticulitis. Dis Colon Rectum. 2009;52(9):1558-63. PubMed PMID: 19690482.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis? AU - Ricciardi,Rocco, AU - Baxter,Nancy N, AU - Read,Thomas E, AU - Marcello,Peter W, AU - Hall,Jason, AU - Roberts,Patricia L, PY - 2009/8/20/entrez PY - 2009/8/20/pubmed PY - 2009/9/16/medline SP - 1558 EP - 63 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 52 IS - 9 N2 - PURPOSE: Indications for operative intervention in the treatment of diverticulitis have become unclear. We hypothesized that surgical treatment for diverticulitis has decreased resulting in proportionately more complicated diverticulitis cases (free perforation and/or abscess). METHODS: We conducted a retrospective analysis of patients with diverticular disease in the Nationwide Inpatient Sample from 1991 through 2005. We used diagnostic codes to identify all patient discharges with diverticular disease and then determined the proportion of discharges with diverticulitis, perforated disease, diverticular abscess, and surgical treatment. RESULTS: During the study period, 685,390 diverticulitis discharges were recorded. The ratio of diverticulitis discharges increased from 5.1 cases per 1,000 inpatients in 1991 to 7.6 cases per 1,000 inpatients in 2005 (P < 0.0001). The proportion of patients who underwent colectomy for uncomplicated diverticulitis declined from 17.9% in 1991 to 13.7% in 2005 (P < 0.0.0001). During the same period, the proportion of free diverticular perforations as a fraction of all diverticulitis cases remained unchanged (1.5%). The proportion of diverticular abscess discharges as a fraction of all diverticulitis cases increased from 5.9% in 1991 to 9.6% in 2005 (P < 0.0001). Last, we noted a decrease in diverticular perforations and/or abscess treated with colectomy, 71.0% in 1991 to 55.5% in 2005 (P < 0.0001). CONCLUSIONS: Despite a significant decline in surgical treatment for diverticulitis, there has been no change in the proportion of patients discharged for free diverticular perforation. There was an increase in diverticular abscess discharges, but this finding was not associated with an increase in same stay surgical treatment. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/19690482/Is_the_decline_in_the_surgical_treatment_for_diverticulitis_associated_with_an_increase_in_complicated_diverticulitis L2 - http://Insights.ovid.com/pubmed?pmid=19690482 DB - PRIME DP - Unbound Medicine ER -