The Impact of Elective Colon Resection on Rates of Emergency Surgery for Diverticulitis

Simianu, Vlad V.; Strate, Lisa L.; Billingham, Richard P.; Fichera, Alessandro; Steele, Scott R.; Thirlby, Richard C.; Flum, David R.

doi:10.1097/sla.0000000000001053

Cited by 41 publications

(30 citation statements)

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“…The incidence of elective colectomy more than doubled, 10-12 despite professional guidelines recommending delaying or, more recently, avoiding elective surgery for uncomplicated diverticulitis. 1,7 However, by focusing only on hospitalized episodes of diverticulitis, this prior research has been limited in answering fundamental questions about proportions of operations that are guideline adherent and factors that might motivate earlier resection.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, the findings in this study may reflect a steady state in laparoscopic colectomy for diverticulitis because the data are from years during which the incidence of elective surgery for diverticulitis seems to have leveled off. 12 The years in which elective surgery had the greatest rise (the early 2000s) predated the availability in 2008 of laparoscopic colectomy procedure codes to investigate this question. 12,33 …”

Section: Discussionmentioning

confidence: 99%

“…12 The years in which elective surgery had the greatest rise (the early 2000s) predated the availability in 2008 of laparoscopic colectomy procedure codes to investigate this question. 12,33 …”

Section: Discussionmentioning

confidence: 99%

“…1 In seeming disconnect with these guidelines, the incidence of elective resection for diverticulitis more than doubled. 10-12 In addition, almost 1 in 3 contemporary operations occurs after only 1 or 2 uncomplicated episodes, 13 raising questions about guideline adherence in these patients.…”

mentioning

confidence: 99%

“…10,15 While more recent guidelines 1,7 no longer recommended earlier resection in younger patients, diverticulitis in the young has risen significantly, 10,11,15,16 and continued reliance on older guidelines may be an explanation. In addition, early elective resection may be attributable to increasingly offered laparoscopic colectomy for diverticular disease, 12 recommended in contemporary guidelines 1 because of lower morbidity, shorter hospitalization, and higher patient satisfaction. 17 As seen with the introduction of laparoscopic approaches to cholecystectomy, the availability of less invasive technology can change the threshold for recommending or accepting the recommendation to undergo an operation.…”

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confidence: 99%

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Number of Diverticulitis Episodes Before Resection and Factors Associated With Earlier Interventions

et al. 2016

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IMPORTANCE Despite professional recommendations to delay elective colon resection for patients with uncomplicated diverticulitis, early surgery (after <3 preceding episodes) appears to be common. Several factors have been suggested to contribute to early surgery, including increasing numbers of younger patients, a lower threshold to operate laparoscopically, and growing recognition of “smoldering” (or nonrecovering) diverticulitis episodes. However, the relevance of these factors in early surgery has not been well tested, and most prior studies have focused on hospitalizations, missing outpatient events and making it difficult to assess guideline adherence in earlier interventions. OBJECTIVE To describe patterns of episodes of diverticulitis before surgery and factors associated with earlier interventions using inpatient, outpatient, and antibiotic prescription claims. DESIGN, SETTING, AND PARTICIPANTS This investigation was a nationwide retrospective cohort study from January 1, 2009, to December 31, 2012. The dates of the analysis were July 2014 to May 2015. Participants were immunocompetent adult patients (age range, 18-64 years) with incident, uncomplicated diverticulitis. EXPOSURE Elective colectomy for diverticulitis. MAIN OUTCOMES AND MEASURES Inpatient, outpatient, and antibiotic prescription claims for diverticulitis captured in the MarketScan (Truven Health Analytics) databases. RESULTS Of 87 461 immunocompetent patients having at least 1 claim for diverticulitis, 6.4% (n = 5604) underwent a resection. The final study cohort comprised 3054 nonimmunocompromised patients who underwent elective resection for uncomplicated diverticulitis, of whom 55.6% (n = 1699) were male. Before elective surgery, they had a mean (SD) of 1.0 (0.9) inpatient claims, 1.5 (1.5) outpatient claims, and 0.5 (1.2) antibiotic prescription claims related to diverticulitis. Resection occurred after fewer than 3 episodes in 94.9% (2897 of 3054) of patients if counting inpatient claims only, in 80.5% (2459 of 3054) if counting inpatient and outpatient claims only, and in 56.3% (1720 of 3054) if counting all types of claims. Based on all types of claims, patients having surgery after fewer than 3 episodes were of similar mean age compared with patients having delayed surgery (both 47.7 years, P = .91), were less likely to undergo laparoscopy (65.1% [1120 of 1720] vs 70.8% [944 of 1334], P = .001), and had more time between the last 2 episodes preceding surgery (157 vs 96 days, P < .001). Patients with health maintenance organization or capitated insurance plans had lower rates of early surgery (50.1% [247 of 493] vs 57.4% [1429 of 2490], P = .01) than those with other insurance plan types. CONCLUSIONS AND RELEVANCE After considering all types of diverticulitis claims, 56.3% (1720 of 3054) of elective resections for uncomplicated diverticulitis occurred after fewer than 3 episodes. Earlier surgery was not explained by younger age, laparoscopy, time between the last 2 episodes preceding surgery, or financial risk-bearing fo...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Number of Diverticulitis Episodes Before Resection and Factors Associated With Earlier Interventions

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Risk of Emergency Surgery or Death After Initial Nonoperative Management of Complicated Diverticulitis in Scotland and Switzerland

Torney

Moffa

Kaech³

et al. 2020

JAMA Surg

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IMPORTANCE National guidelines on interval resection for prevention of recurrence after complicated diverticulitis are inconsistent. Although US and German guidelines favor interval colonic resection to prevent a perceived high risk of recurrence, UK guidelines do not.OBJECTIVES To investigate patient management and outcomes after an index inpatient episode of nonoperatively managed complicated diverticulitis in Switzerland and Scotland and determine whether interval resection was associated with the rate of disease-specific emergency surgery or death in either country. DESIGN, SETTING, AND PARTICIPANTSThis secondary analysis of anonymized complete national inpatient data sets included all patients with an inpatient episode of successfully nonoperatively managed complicated diverticulitis in Switzerland and Scotland from January 1, 2005, to December 31, 2015. The 2 countries have contrasting health care systems: Switzerland is insurance funded, while Scotland is state funded. Statistical analysis was conducted from February 1, 2018, to October 17, 2019. MAIN OUTCOMES AND MEASURESThe primary end point defined a priori before the analysis was adverse outcome, defined as any disease-specific emergency surgical intervention or inpatient death after the initial successful nonsurgical inpatient management of an episode of complicated diverticulitis, including complications from interval elective surgery. RESULTSThe study cohort comprised 13 861 inpatients in Switzerland (6967 women) and 5129 inpatients in Scotland (2804 women) with an index episode of complicated acute diverticulitis managed nonoperatively. The primary end point was observed in 698 Swiss patients (5.0%) and 255 Scottish patients (5.0%) (odds ratio, 0.98; 95% CI, 0.81-1.19). Elective interval colonic resection was undertaken in 3280 Swiss patients (23.7%; median follow-up, 53 months [interquartile range, 24-90 months]) and 231 Scottish patients (4.5%; median follow-up, 57 months [interquartile range, 27-91 months]). Death after urgent readmission for recurrent diverticulitis occurred in 104 patients (0.8%) in Switzerland and 65 patients (1.3%) in Scotland. None of the investigated confounders had a significant association with the outcome apart from comorbidity.CONCLUSIONS AND RELEVANCE This study found no difference in the rate of adverse outcome (emergency surgery and/or inpatient death) despite a 5-fold difference in interval resection rates.

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Prophylactic Colon and Rectum Resections for Benign Pathologies

Mantoğlu

Fırat

Altıntoprak

2021

Prophylactic Surgery

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The Impact of Elective Colon Resection on Rates of Emergency Surgery for Diverticulitis

Cited by 41 publications

References 41 publications

Number of Diverticulitis Episodes Before Resection and Factors Associated With Earlier Interventions

Number of Diverticulitis Episodes Before Resection and Factors Associated With Earlier Interventions

Risk of Emergency Surgery or Death After Initial Nonoperative Management of Complicated Diverticulitis in Scotland and Switzerland

Prophylactic Colon and Rectum Resections for Benign Pathologies

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