Practice Parameters for the Treatment of Sigmoid Diverticulitis

Feingold, Daniel L.; Steele, Scott R.; Lee, Sang; Kaiser, Andreas M.; Boushey, Robin P.; Buie, W. Donald; Rafferty, Janice

doi:10.1097/dcr.0000000000000075

Cited by 511 publications

(536 citation statements)

References 98 publications

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“…2 The lack of defined and clear indications for surgery in acute diverticulitis renders the decision-making for surgery nonstandard and subject to interpretation. This variability can be used to explain practice pattern determinants, identify downstream consequences, and guide policy.…”

Section: Discussionmentioning

confidence: 99%

“…Elective prophylactic colectomy has historically been recommended for patients with multiple bouts of diverticulitis, with or without complicated disease, but guidelines have changed considerably [1]. The newest ASCRS practice parameters suggest the old model of diverticulitis as a progressive disease, in which recurrences predict poor outcomes, may be outdated [2,3]. As such, elective colectomy for younger patients (<50 years) with one attack of diverticulitis is no longer recommended [2].…”

Section: Introductionmentioning

confidence: 99%

“…The newest ASCRS practice parameters suggest the old model of diverticulitis as a progressive disease, in which recurrences predict poor outcomes, may be outdated [2,3]. As such, elective colectomy for younger patients (<50 years) with one attack of diverticulitis is no longer recommended [2]. In addition, though non-operative treatment with antibiotics is still recommended, the newest ASCRS guidelines acknowledge that the necessity of antibiotics has been called into question by recent research [2,[4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…As such, elective colectomy for younger patients (<50 years) with one attack of diverticulitis is no longer recommended [2]. In addition, though non-operative treatment with antibiotics is still recommended, the newest ASCRS guidelines acknowledge that the necessity of antibiotics has been called into question by recent research [2,[4][5][6]. Although new data have led to some of these shifts in recommendations, variation in disease presentation and clinical course as well as provider judgment rather than any generalized protocol are likely to lead to confusion regarding care paths [2,7].…”

Section: Introductionmentioning

confidence: 99%

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Population Based Analysis of Surgical Care for Diverticulitis

Ricciardi¹

2017

GHOA

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Background: Surgical treatment of diverticulitis lacks clear and consistent guidelines leading to potential variability based on treatment location. Our aim was to evaluate and explain geographic variability in resection rates for diverticulitis. Methods:We performed a retrospective review of all-payer state hospital discharge data from 20 U.S. states merged with surgeon distribution data from the American Board of Medical Specialties. Resection rates were calculated for a total population of 137,793,346 in 687 counties. Then, we identified factors associated with high surgical resection rates by merging the county data resection rates with diverticular disease burden rates, surgeon distribution data from the American Board of Medical Specialties, U.S. Census data, and the Dartmouth Atlas of Healthcare Resource Files.Results: Among the 362,401 total inpatient diverticulitis discharges, 326,437 (90.1%) were uncomplicated, and 35,964 (9.9%) were complicated. A total of 80,546 resections were performed (22.7%). Mean total resection rate varied among states from a low of 13% in West Virginia to a high of 31% in Washington. Multivariate analysis revealed an association between surgeon practice location and increased likelihood of resection. There was no correlation between the resection rate and county diverticular disease burden (p < 0.01 for both analyses). Conclusion:Geographic variation in resection rates for diverticulitis may be influenced by the availability of surgeons rather than disease rates. These results suggest further standardization is warranted to identify evidence based guidelines for surgical intervention. Keywords: Materials and Methods Data source-AHRQWe obtained state discharge data from the Agency for Healthcare Research and Quality (AHRQ) [14]. The agency works to disseminate and provide resources for national healthcare data. These data included county-level place of residence information for: Arizona, Colorado, Florida, Iowa, Kentucky, Maryland, Michigan, North Carolina, Nebraska, New Jersey, New York, Oregon, Rhode Island, South Carolina, Utah, Vermont, Washington, Wisconsin, and West Virginia. California state hospital discharge data was obtained from the Office of Statewide Health Planning and Development in California. We signed a data-use agreement with AHRQ and the California Office of Statewide Health Planning and Development. Our study protocol was considered exempt by the Lahey Hospital & Medical Center Institutional Review Board. Data source-U.S. CensusWe used U.S. census data from the 2000 U.S. Census to identify county level demographics for all counties sampled [15]. Specifically, we abstracted the following county level demographic variables: population total, persons per household, percent over 65 years of age, percent female, percent Black, percent owning own home, and percent who speak a language other than English.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Population Based Analysis of Surgical Care for Diverticulitis

Ricciardi¹

2017

GHOA

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“…[37] Need for colonoscopy at follow up Current guidelines still recommend routine follow-up colonoscopy after a first attack of acute diverticulitis to confirm the diagnosis and exclude malignancy. [38] The recommendation for colonoscopy after an episode of acute diverticulitis is merely based on expert opinion and dates back to the time before widespread use of CT to diagnose acute diverticulitis. Colonoscopy is burdensome, costly, timeconsuming, and has the risk of procedure-related morbidity.…”

Section: Mortalitymentioning

confidence: 99%