Insurance But Not Race Is Associated With Diverticulitis Mortality in a Statewide Database

Ho, Vanessa P.; Nash, Garrett M.; Feldman, Evan N.; Trencheva, Koiana; Milsom, Jeffrey W.; Lee, Sang W.

doi:10.1007/dcr.0b013e31820d188f

Cited by 27 publications

(17 citation statements)

References 26 publications

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“…Our finding of a greater risk for mortality among diverticulitis patients with insurance coverage other than a private provider has also been previously demonstrated (21,22). Although Ho et al (22) also found no increased risk for mortality among black patients compared with non-Hispanic white patients, others studies have demonstrated an increased risk for mortality among African Americans (21,23,24). Furthermore, to our knowledge, the present study was the first to use ICD-9-CM diagnostic codes in an administrative database to stratify diverticulitis patients according to disease severity according to the Hinchey classification.…”

Section: Discussionsupporting

confidence: 84%

“…Similar to findings in Etzioni et al (20), we also demonstrated an increased risk for mortality among patients who were either older, undergoing surgery, or admitted emergently or urgently, as well as a temporal trend of decreased mortality over the course of the study period. Our finding of a greater risk for mortality among diverticulitis patients with insurance coverage other than a private provider has also been previously demonstrated (21,22). Although Ho et al (22) also found no increased risk for mortality among black patients compared with non-Hispanic white patients, others studies have demonstrated an increased risk for mortality among African Americans (21,23,24).…”

Section: Discussionsupporting

confidence: 84%

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Hospital Volume and Other Risk Factors for In-Hospital Mortality among Diverticulitis Patients: A Nationwide Analysis

Diamant

Coward

Buie

et al. 2015

Canadian Journal of Gastroenterology and Hepatology

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BACKGROUND: Previous studies have found that a higher volume of colorectal surgery was associated with lower mortality rates. While diverticulitis is an increasingly common condition, the effect of hospital volume on outcomes among diverticulitis patients is unknown.OBJECTIVE: To evaluate the relationship between hospital volume and other factors on in-hospital mortality among patients admitted for diverticulitis.METHODS: Data from the Nationwide Inpatient Sample (years 1993 to 2008) were analyzed to identify 822,865 patients representing 4,108,726 admissions for diverticulitis. Hospitals were divided into quartiles based on the volume of diverticulitis cases admitted over the study period, adjusted for years contributed to the dataset. Mortality according to hospital volume was modelled using logistic regression adjusting for age, sex, race, comorbidities, health care insurance, admission type, calendar year, colectomy, disease severity and clustering. Risk estimates were expressed as adjusted ORs with 95% CIs.RESULTS: Patients at high-volume hospitals were more likely to be admitted emergently, undergo surgical treatment and have more severe disease. In-hospital mortality was higher among the lowest quartile of hospital volume compared with the highest volume (OR 1.13 [95% CI 1.05 to 1.21]). In-hospital mortality was increased among patients admitted emergently (OR 2.58 [95% CI 2.40 to 2.78]) as well as those receiving surgical treatment (OR 3.60 [95% CI 3.42 to 3.78]).CONCLUSIONS: Diverticulitis patients admitted to hospitals with a low volume of diverticulitis cases had an increased risk for death compared with those admitted to high-volume centres.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 84%

Hospital Volume and Other Risk Factors for In-Hospital Mortality among Diverticulitis Patients: A Nationwide Analysis

Diamant

Coward

Buie

et al. 2015

Canadian Journal of Gastroenterology and Hepatology

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“…18 Other studies combine Native Americans with Asians or report data limited to White and Black patients. 3, 19, 20 Indeed, the number of Native American individuals is proportionately small and our results for this group are less stable than for Whites and Blacks. In addition, possible differential coding of race and/or and care practices over time may have influenced the results in this group.…”

Section: Discussioncontrasting

confidence: 68%

Trends in Hospitalization for Diverticulitis and Diverticular Bleeding in the United States From 2000 to 2010

Wheat

Strate

2016

Clinical Gastroenterology and Hepatology

146

105

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Background & Aims Most studies of trends in diverticular disease have focused on diverticulitis or on a composite outcome of diverticulitis and bleeding. We aimed to quantify and compare the prevalence of hospitalization for diverticular bleeding and diverticulitis overall and by sex and race. Methods We analyzed data from the Nationwide Inpatient Sample from 2000 through 2010. We identified adult patients with a discharge diagnosis of diverticular bleeding or diverticulitis. Using yearly US Intercensal data, we calculated age-, sex-, and race- specific rates, as well as age-adjusted prevalence rates. Results The prevalence of hospitalization per 100,000 persons for diverticular bleeding decreased over the 10 year (y) period from 32.5 to 27.1 (−5.4; 95% confidence interval (CI), −5.1 to −5.7). The prevalence of hospitalization for diverticulitis peaked in 2008 (74.1/100,000 in 2000, 96.0/100,000 in 2008 and 91.9/100,000 in 2010). The prevalence of diverticulitis was higher in women than men, whereas women and men had similar rates of diverticular bleeding. The prevalence of diverticular bleeding was highest in Blacks (34.4/100,000 in 2010); whereas the prevalence of diverticulitis was highest in Whites (75.5/100,000 in 2010). Conclusions Over the past 10 y, the prevalence of hospitalization for diverticulitis increased and then plateaued while that of diverticular bleeding decreased. The prevalence according to sex and race differed for diverticulitis and diverticular bleeding. These findings indicate different mechanisms of pathogenesis for these disorders.

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“…Reported mortality rates among patients undergoing urgent colorectal surgery range from 3% to 25%. 4,41,43 Our mortality of approximately 4.5% in the present study falls in the lower range. It has been suggested that understaffing on weekends is the main cause of the weekend effect.…”

Section: Commentmentioning

confidence: 61%

Worse Outcomes in Patients Undergoing Urgent Surgery for Left-Sided Diverticulitis Admitted on Weekends vs Weekdays

Worni¹,

Schudel²,

Østbye³

et al. 2012

Arch Surg

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Hypothesis: Among patients undergoing urgent surgery for left-sided diverticulitis, those admitted on weekends vs weekdays have higher rates of Hartmann procedure and adverse outcomes.Design: Analysis of data from the Nationwide Inpatient Sample between January 2002 and December 2008. Unadjusted and risk-adjusted generalized linear regression models were used.Setting: Academic research.Patients: Data on patients undergoing urgent surgery for acute diverticulitis.Main Outcome Measures: Rates of Hartmann procedure vs primary anastomosis, complications, length of hospital stay, and total hospital charges.Results: In total, 31 832 patients were included; 7066 (22.2%) were admitted on weekends, and 24 766 (77.8%) were admitted on weekdays. The mean (SD) age of patients was 60.8 (15.3) years, and 16 830 (52.9%) were female. A Hartmann procedure was performed in 4580 patients (64.8%) admitted on weekends compared with 13 351 patients (53.9%) admitted on weekdays (riskadjusted odds ratio [OR], 1.57; P Ͻ .001). In riskadjusted analyses, patients admitted on weekends had significantly higher risk for any postoperative complication (OR, 1.10; P=.005) and nonroutine hospital discharge (OR, 1.33; PϽ.001) compared with patients admitted on weekdays, as well as a median length of hospital stay that was 0.5 days longer and median total hospital charges that were $3734 higher (PϽ .001 for both).Conclusions: Patients undergoing urgent surgery for leftsided diverticulitis who are admitted on a weekend have a higher risk for undergoing a Hartmann procedure and worse short-term outcomes compared with patients who are admitted on a weekday. Further research is warranted to investigate possible underlying mechanisms and to develop strategies for reducing this substantial weekend effect.

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Insurance But Not Race Is Associated With Diverticulitis Mortality in a Statewide Database

Cited by 27 publications

References 26 publications

Hospital Volume and Other Risk Factors for In-Hospital Mortality among Diverticulitis Patients: A Nationwide Analysis

Hospital Volume and Other Risk Factors for In-Hospital Mortality among Diverticulitis Patients: A Nationwide Analysis

Trends in Hospitalization for Diverticulitis and Diverticular Bleeding in the United States From 2000 to 2010

Worse Outcomes in Patients Undergoing Urgent Surgery for Left-Sided Diverticulitis Admitted on Weekends vs Weekdays

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