Trends in diverticulitis management in the United States from 2002 to 2007

Arch Surg. 2011 Apr;146(4):400-6. doi: 10.1001/archsurg.2010.276. Epub 2010 Dec 20.

Abstract

Objective: To demonstrate the recent trends of admission and surgical management for diverticulitis in the United States.

Design: Retrospective database analysis.

Setting: The National Inpatient Sample database.

Patients: Patients admitted to the hospital for diverticulitis from 2002 to 2007.

Main outcome measures: Patient characteristics, surgical approach, and mortality were evaluated for elective or emergent admission.

Results: A total of 1,073,397 patients were admitted with diverticulitis (emergent: 78.3%, elective: 21.7%). The emergent admission rate increased by 9.5% over the study period. For emergent patients, 12.2% underwent urgent surgical resection and 87.8% were treated with nonoperative methods (percutaneous abscess drainage: 1.88% and medical treatment: 85.92%). There was only a 4.3% increase in urgent surgical resections, while elective surgical resections increased by 38.7.%. The overall rate of elective laparoscopic colon resection was 10.5%. Elective laparoscopic surgery nearly doubled from 6.9% in 2002 to 13.5% in 2007 (P < .001). Primary anastomosis rates increased for elective resections over time (92.1% in 2002 to 94.5% in 2007; P < .001). For urgent open operation, use of colostomy decreased significantly from 61.2% in 2002 to 54.0% in 2007 (P < .001). In-hospital mortality significantly decreased in both elective and urgent surgery (elective: 0.53% in 2002 to 0.44% in 2007; P = .001; urgent: 4.5% in 2002 to 2.5% in 2007; P < .001).

Conclusion: Diverticulitis continues to be a source of significant morbidity in the United States. However, our data show a trend toward increased use of laparoscopic techniques for elective operations and primary anastomosis for urgent operations.

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Anastomosis, Surgical / statistics & numerical data
  • Colectomy / methods
  • Colectomy / mortality
  • Colectomy / statistics & numerical data*
  • Colectomy / trends
  • Colostomy / mortality
  • Colostomy / statistics & numerical data*
  • Colostomy / trends
  • Databases, Factual
  • Diverticulitis / epidemiology
  • Diverticulitis / surgery
  • Diverticulitis / therapy*
  • Elective Surgical Procedures / statistics & numerical data
  • Emergencies
  • Female
  • Hospital Mortality
  • Humans
  • Incidence
  • Laparoscopy / mortality
  • Laparoscopy / statistics & numerical data*
  • Laparoscopy / trends
  • Length of Stay
  • Male
  • Medical Records
  • Middle Aged
  • Multivariate Analysis
  • Patient Admission / statistics & numerical data*
  • Patient Admission / trends
  • Recurrence
  • Retrospective Studies
  • Survival Rate
  • United States / epidemiology