Adherence to clinical guidelines and the potential economic benefits of admission avoidance for acute uncomplicated diverticulitis
- 160 Downloads
Abstract
Background
The treatment paradigm for acute diverticulitis is changing. There is an increasing trend towards managing patients with uncomplicated diverticulitis in the community.
Aims
The aim of this study was to analyse how acute diverticulitis is managed in our institution and also to analyse national data pertaining to treatment of acute diverticulitis.
Methods
A prospective database of all patients admitted to our institution over a 2-year period (2014–2016) with acute diverticulitis was maintained. Severity of disease, treatment received and average length of stay (LOS) were analysed for all patients. Contemporaneous hospital inpatient enquiry (HIPE) data was interrogated to analyse current management for acute diverticulitis at a national level.
Results
One hundred twenty-six patients were admitted to our institution with acute diverticulitis during the study period (inpatient stay = €1277/night). Of patients, 59.5% had uncomplicated diverticulitis while 40.5% had complicated disease. The median LOS was 4 (range 1–34) days and 8 (range 2–51) days in the uncomplicated and complicated group, respectively. Based on HIPE data, there were 11,357 patients with uncomplicated diverticulitis and 526 patients with complicated diverticulitis admitted to Irish hospitals in the year 2015. Nationally, the median LOS for those with uncomplicated diverticulitis was 3 (range 1–142) days and for those with complicated diverticulitis the median LOS was 7 (range 1–308) days. Projected total cost for hospital stay nationally for uncomplicated diverticulitis amounted to €43.5 million for the year 2015.
Conclusions
At present, uncomplicated diverticulitis in Ireland is not being managed as per evidence-based guidelines. Changing practice could result in significant cost savings for surgical departments.
Keywords
Acute diverticulitis Complicated diverticulitis Danish guidelines Length of stay Uncomplicated diverticulitisNotes
Compliance with ethical standards
Funding
There was no source of funding for this article.
Conflict of interest
Ian S. Reynolds declares that he has no conflict of interest, Emer O’Connell declares that she has no conflict of interest, Roisin M. Heaney declares that she has no conflict of interest, Waqar Khan declares that he has no conflict of interest, Iqbal Z. Khan declares that he has no conflict of interest, Ronan Waldron declares that he has no conflict of interest and Kevin Barry declares that he has no conflict of interest.
Ethical approval
Ethical approval to conduct all aspects of this study was granted by the hospital research ethics committee at Mayo University Hospital.
Informed consent
Informed consent was not necessary for this study.
References
- 1.Kang JY, Hoare J, Tinto A et al (2003) Diverticular disease of the colon on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 17(9):1189–1195CrossRefPubMedGoogle Scholar
- 2.Etzioni DA, Mack TM, Beart RW et al (2009) Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg 249(2):210–217CrossRefPubMedGoogle Scholar
- 3.Murphy SF, Waters PS, Waldron RM et al (2015) Predictive factors for colonic resection in patients less than 49 years with symptomatic diverticular disease. Am J Surg. doi: 10.1016/j.amjsurg.2015.09.013
- 4.Andersen JC, Bundgaard L, Elbrønd H et al (2012) Danish national guidelines for treatment of diverticular disease. Dan Med J 59(5):C4453PubMedGoogle Scholar
- 5.Buchs NC, Konrad-mugnier B, Jannot AS et al (2013) Assessment of recurrence and complications following uncomplicated diverticulitis. Br J Surg 100(7):976–979CrossRefPubMedGoogle Scholar
- 6.Biondo S, Golda T, Kreisler E et al (2014) Outpatient versus hospitalization management for uncomplicated diverticulitis. Ann Surg 259(1):38–44CrossRefPubMedGoogle Scholar
- 7.Chabok A, Påhlman L, Hjern F et al (2012) Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 99(4):532–539CrossRefPubMedGoogle Scholar
- 8.Andeweg CS, Mulder IM, Felt-Bersma RJ, Netherlands Society of Surgery; Working group from Netherlands Societies of Internal Medicine, Gastroenterologists, Radiology, Health echnology Assessment and Dieticians et al (2013) Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg 30(4–6):278–292CrossRefPubMedGoogle Scholar
- 9.Balasubramanian I, Fleming C, Mohan HM et al (2017) Out-patient management of mild or uncomplicated diverticulitis: a systematic review. Dig Surg 34:151–160CrossRefPubMedGoogle Scholar
- 10.O’Leary DP, Lynch N, Clancy C et al (2015) International, expert-based, consensus statement regarding the management of acute diverticulitis. JAMA Surg 150(9):899–904CrossRefPubMedGoogle Scholar
- 11.Khan DZ, Kelly ME, O’Reilly J et al (2016) A national evaluation of the management practices of acute diverticulitis. SurgeonGoogle Scholar
- 12.Papagrigoriadis S, Debrah S, Koreli A et al (2004) Impact of diverticular disease on hospital costs and activity. Color Dis 6(2):81–84CrossRefGoogle Scholar
- 13.Jackson JD, Hammond T (2014) Systematic review: outpatient management of acute uncomplicated diverticulitis. Int J Color Dis 29(7):775–781CrossRefGoogle Scholar
- 14.Isacson D, Andreasson K, Nikberg M et al (2014) No antibiotics in acute uncomplicated diverticulitis: does it work? Scand J Gastroenterol 49(12):1441–1446CrossRefPubMedGoogle Scholar
- 15.Isacson D, Thorisson A, Andreasson K et al (2015) Outpatients, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study. Int J Color Dis 30(9):1229–1234CrossRefGoogle Scholar
- 16.Salem TA, Molloy RG, O’Dwyer PJ (2007) Prospective, five-year follow-up study of patients with symptomatic uncomplicated diverticular disease. Dis Colon rectum 50(9):1460–1464Google Scholar
- 17.Chautems RC, Ambrosetti P, Ludwig A et al (2002) Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?; a prospective study of 118 patients. Dis Colon rectum 45(7):962–966Google Scholar