Diverticulitis patient care during the Covid-19 pandemic in Germany—a retrospective nationwide population-based cohort study

Abstract

Purpose Coronavirus disease 2019 (COVID-19) impacted health care systems around the world. Despite a decrease in emergency admissions, an increased number of complicated forms of diverticulitis was reported. It was the aim of this study to analyze the pandemic impact on diverticulitis management in Germany. Methods This is a retrospective population-wide analysis of hospital billing data (2012–2021) of diverticulitis in Germany. Patients were identified based on diagnosis (ICD10) and procedural codes to stratify by conservative and operative management. Primary outcome of interest was admission rates, secondary outcomes were rates of surgical vs conservative treatment and fraction of complicated clinical courses during the pandemic. Results Of a total of 991,579 cases, 66,424 (6.7%) were admitted during pandemic lockdowns. Conservative treatment was the most common overall (66.9%) and higher during lockdowns (70.7%). Overall admissions and population adjusted rates of surgically treated patients decreased, the latter by 12.7% and 11.3%, corrected to estimated rates, in the two lockdowns. Surgery after emergency presentation decreased by 7.1% (p=0.053) and 11.1% (p=0.002) in the two lockdowns with a higher rate of ostomy and/or revision (+5.6%, p=0.219, and +10.2%, p=0.030). In-hospital mortality was increased in lockdown periods (1.64% vs 1.49%). In detail, mortality was identical in case of conservative treatment during lockdown periods (0.5%) but was higher in surgically treated patients (4.4% vs 3.6%). Conclusion During lockdowns, there was an overall decrease of admissions for diverticulitis, especially non-emergency admissions in Germany, and treatment was more likely to be conservative. In case of surgery, however, there was increased risk of a complicated course (ostomy, re-surgery), possibly due to patient selection.

Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature

“…Additionally, there are still instances of COVID-19 patients experiencing a worsening of their diverticular disease, which may be attributed to the effect of the virus on the immune system. Therefore, it is crucial to raise awareness about the risks of delaying medical care and to encourage patients to seek timely treatment to avoid potentially life-threatening complications [35][36][37].…”

“…Due to the rarity of the disease, there are instances in the literature where the diagnosis was not clearly established before the exploratory intervention but only during exploratory laparoscopy. In our cases, the preoperative CT scan was exact for the site and the number of the ill-defined diverticula [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44].…”