Abstract
Background
International comparison of outcomes of surgical diseases has become a global focus because of widespread concern over surgical quality, rising costs and the value of healthcare. Acute diverticulitis is a common disease potentially amenable to optimization of strategies for operative intervention. The aim was to compare the emergency operative intervention rates for acute diverticulitis in USA, England and Australia.
Methods
Unplanned admissions for acute diverticulitis were found from an international administrative dataset between 2008 and 2014 for hospitals in USA, England and Australia. The primary outcome measured was emergency operative intervention rate. Secondary outcomes included inpatient mortality and percutaneous drainage rate. Multivariable analysis was performed after development of a weighted comorbidity scoring system.
Results
There were 15,150 unplanned admissions for acute diverticulitis. The emergency operative intervention rates were 16, 13 and 10% for USA, England and Australia. The percutaneous drainage rate was highest in USA at 10%, while the mortality rate was highest in England at 2.8%. The propensity for emergency operative intervention was higher in USA (OR 1.45, p < 0.001) and England (OR 1.49, p < 0.001) than in Australia. The risk of 7-day mortality was higher in England than in Australia (OR 2.79, p < 0.001). Percutaneous drainage was associated with reduced 7-day mortality risk.
Conclusion
Australia has a lower propensity for emergency operative intervention, while England has a greater risk of mortality for acute diverticulitis. International variations raise the issue of healthcare value in terms of differing resource use and outcomes.
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References
Regenbogen SE, Hardiman KM, Hendren S et al (2014) Surgery for diverticulitis in the 21st century: a systematic review. JAMA Surg 149:292–303
Yen L, Davis KL, Hodgkins P et al (2012) Direct costs of diverticulitis in a US managed care population. Am J Pharm Benefits 4:e118–e129
Ricciardi R, Baxter NN, Read TE et al (2009) Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis? Dis Colon Rectum 52:1558–1563
Li D, Baxter NN, McLeod RS et al (2014) Evolving practice patterns in the management of acute colonic diverticulitis: a population-based analysis. Dis Colon Rectum 57:1397–1405
Paterson HM, Arnott ID, Nicholls RJ et al (2015) Diverticular disease in Scotland: 2000–2010. Colorectal Dis 17:329–334
Vather R, Broad JB, Jaung R et al (2015) Demographics and trends in the acute presentation of diverticular disease: a national study. ANZ J Surg 85(10):744–748
Etzioni DA, Mack TM, Beart RW Jr et al (2009) Diverticulitis in the United States: 1998-2005—changing patterns of disease and treatment. Ann Surg 249:210–217
Papagrigoriadis S, Debrah S, Koreli A et al (2004) Impact of diverticular disease on hospital costs and activity. Colorectal Dis 6:81–84
Woolf SH, Aron LY (2013) The US health disadvantage relative to other high-income countries: findings from a National Research Council/Institute of Medicine report. JAMA 309:771–772
Porter ME (2010) What is value in health care? N Engl J Med 363:2477–2481
Bottle A, Middleton S, Kalkman CJ et al (2013) Global comparators project: international comparison of hospital outcomes using administrative data. Health Serv Res 48:2081–2210
Hong MK, Tomlin AM, Hayes IP et al (2015) Operative intervention rates for acute diverticulitis: a multicentre state-wide study. ANZ J Surg 85:734–738
Hong MK, Skandarajah AR, Faiz OD et al (2016) How to use administrative data for surgical outcomes in acute diverticulitis. Gen Surg. doi:10.18282/gs.v1.i1.32
Elixhauser A, Steiner C, Harris DR et al (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27
van Walraven C, Austin PC, Jennings A et al (2009) A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care 47:626–633
Rose J, Parina RP, Faiz O et al (2015) Long-term outcomes after initial presentation of diverticulitis. Ann Surg 262(6):1046–1053
Salem L, Anaya DA, Flum DR (2005) Temporal changes in the management of diverticulitis. J Surg Res 124:318–323
Mills AM, Holena DN, Kallan MJ et al (2013) Effect of insurance status on patients admitted for acute diverticulitis. Colorectal Dis 15:613–662
Saunders DI, Murray D, Pichel AC et al (2012) Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network. Br J Anaesth 109:368–375
Clarke A, Murdoch H, Thomas MJ et al (2011) Mortality and postoperative care after emergency laparotomy. Eur J Anaesthesiol 28:16–19
Dharmarajan S, Hunt S, Birnbaum E et al (2011) The efficacy of nonoperative management of acute complicated diverticulitis. Dis Colon Rectum 54:663–671
Elagili F, Stocchi L, Ozuner G et al (2014) Outcomes of percutaneous drainage without surgery for patients with diverticular abscess. Dis Colon Rectum 57:331–336
Singh B, May K, Coltart I et al (2008) The long-term results of percutaneous drainage of diverticular abscess. Ann R Coll Surg Engl 90:297–301
Gaertner WB, Willis DJ, Madoff RD et al (2013) Percutaneous drainage of colonic diverticular abscess: is colon resection necessary? Dis Colon Rectum 56:622–626
Felder SI, Barmparas G, Lynn J et al (2013) Can the need for colectomy after computed tomography-guided percutaneous drainage for diverticular abscess be predicted? Am Surg 79:1013–1016
Acknowledgements
We thank all the members of the GI GOAL group in the Dr Foster Global Comparators collaboration. We especially thank Dr David Chang for his valuable suggestions. We are also grateful for the support provided by the Melville-Hughes Scholarship, the University of Melbourne.
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Hong, M.K.Y., Skandarajah, A.R., Higgins, R.D. et al. International Variation in Emergency Operation Rates for Acute Diverticulitis: Insights into Healthcare Value. World J Surg 41, 2121–2127 (2017). https://doi.org/10.1007/s00268-017-3965-z
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DOI: https://doi.org/10.1007/s00268-017-3965-z