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Trends in emergent diverticular disease management: a nationwide cohort study from 2009 to 2018

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Abstract

Background

Diverticular disease is a common disorder. Several guidelines report on its optimal management. The aim of this study was to describe the evolution of the prevalence of this disease, the treatment strategies, and the mortality rate on a national level.

Methods

We conducted a retrospective study on prospective data using a nationwide database. All consecutive adult patients diagnosed with diverticular disease and admitted via the emergency department from 2009 to 2018 were included in the study. We performed a descriptive analysis for epidemiologic data, diagnosis, and treatment.

Results

During the data collection period, 233,386 patients were included in the study. The number of admissions for emergent diverticular disease increased by 65.8%, from 16,754 in 2009 to 27,781 in 2018, for both uncomplicated and complicated diverticular disease. Among these patients, 19,350 (8.3%) were operated on. The rate of surgical treatment progressively decreased from 9.7% in 2009 to 7.6% in 2018. The three main interventions were Hartmann’s procedure (HP, n = 9111, 47.1%), resection with primary anastomosis (RPA, n = 4335, 22.4%), and peritoneal lavage (PL, n = 4836, 25%). We observed a progressive annual increase in HPs (n = 716 in 2009 and n = 1055 in 2018) as well as a decline in PLs since 2015, while the number of RPAs remained stable.

Conclusions

Although admissions for emergent diverticular disease have increased during the study period, the rate of surgical treatment has decreased, suggesting an evolution toward more conservative management of this pathology.

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Author information

Authors and Affiliations

  1. Department of Endocrine and Digestive Surgery, Sorbonne Université, Hospital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France

    S. Martellotto

  2. Department of Digestive Surgery, Université de Paris, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

    A. Challine

  3. Department of Digestive Surgery and Obesity, Centre Hospitalier Intercommunal de Créteil, Créteil, France

    V. Peveri, L. Paolino & A. Lazzati

  4. UMR_S 1138, Centre de Recherche Des Cordeliers, INSERM, Université Paris Descartes, 75006, Paris, France

    A. Challine & A. Lazzati

Authors
  1. S. Martellotto
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  2. A. Challine
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  4. L. Paolino
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  5. A. Lazzati
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Contributions

SM and AL: conceptualization; SM: data curation, SM and AL: formal analysis; SM: investigation; SM and AL: methodology; AL: project administration; SM and AL: software; AL: supervision; SM, AL, and AC: validation; SM, AL, and AC: visualization; SM, AL, and AC: writing—original draft; SM, AL, AC, VP, and LP: writing—review and editing. All authors give their final approval of the version to be published, and their agreement to be accountable for all aspects of the work.

Corresponding author

Correspondence to S. Martellotto.

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Conflict of interest

The authors declare that they have no conflict of interest.

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None.

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Appendix

Appendix

 

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Difference 2009–2018 (%)

Admissions

 Age < 60

6965

7602

8669

9714

10,033

10,954

11,477

11,866

12,093

12,107

74%

 Age 60–75

4403

4671

5365

5949

6259

6880

7256

7691

8101

8277

88%

 Age > 75

5386

5738

6117

6785

6590

7105

7226

7413

7297

7397

37%

General population (thousands)

 Age < 60

49,974.6

50,010.4

50,046.2

50,082.0

50,117.9

50,153.7

50,115.8

49,985.3

49,833.8

49,634.5

− 1%

 Age 60–75

8681.6

8942.4

9203.3

9464.1

9724.9

9985.8

10,235.7

10,516.6

10,804.1

11,042.5

27%

 Age > 75

5577.2

5660.1

5742.9

5825.8

5908.6

5991.5

6071.0

6100.8

6143.3

6200.1

11%

Incidence, nb/100,000 inhabitants

 Age < 60

13.9

15.2

17.3

19.4

20.0

21.8

22.9

23.7

24.3

24.4

76%

 Age 60–75

50.7

52.2

58.3

62.9

64.4

68.9

70.9

73.1

75.0

75.0

48%

 Age > 75

96.6

101.4

106.5

116.5

111.5

118.6

119.0

121.5

118.8

119.3

23%

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Martellotto, S., Challine, A., Peveri, V. et al. Trends in emergent diverticular disease management: a nationwide cohort study from 2009 to 2018. Tech Coloproctol 25, 549–558 (2021). https://doi.org/10.1007/s10151-021-02423-w

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