The price of decreased mortality in the operative management of diverticulitis

Abstract

Background: Healthcare costs in the United States are increasing. It is thought that as cost increases, outcomes should improve. The aim of this study was to analyze patient charges and mortality in the operative management of diverticulitis over time.

Methods: A retrospective analysis of the Nationwide Inpatient Sample database was performed. Adults with diverticulitis who underwent laparoscopic or open partial colectomy were identified by ICD-9 codes. Multivariate analyses examined in-hospital mortality and total charges. Results were adjusted for age, race, gender, Charlson comorbidity index, surgical approach (open vs. laparoscopic), and insurance status.

Results: From 1998 to 2010, 148,348 patients had a partial colectomy for diverticulitis. After adjusting for other covariates and inflation, the average charge of hospitalization per admission increased by $34,057 from 1998 to 2010. In the same observation period, adjusted in-hospital mortality decreased significantly by 2005 compared to 1998 (p < 0.001, OR 0.77, 95% CI 0.68-0.88) and remained unchanged for the remainder of the study period. Additionally, laparoscopic management was associated with lower rate of charge increase compared to open management (p < 0.001), such that charges are currently higher for open management than laparoscopic.

Conclusion: In-hospital mortality following partial colectomy for diverticulitis has improved over time, most dramatically after 2005. With decreasing mortality, an increase in hospital charges is observed on an annual basis. However, while mortality reached a plateau after 2005, overall charges continue to rise.