This nationwide retrospective cohort study describes patterns of episodes of diverticulitis before surgery and factors associated with earlier interventions using inpatient, outpatient, and antibiotic prescription claims.
This study surveyed diverticulitis experts to create a consensus statement regarding the treatment of acute diverticulitis.
This study shows that low UV light exposure is associated with an increased rate of diverticulitis admissions and greater seasonal variation and supports a role for vitamin D in the pathogenesis of diverticulitis.
Regenbogen et al review and classify the primary data published since 2000 that are guiding decision making, technical considerations, and the outcomes of surgery for sigmoid diverticulitis.
To demonstrate the recent trends of admission and surgical management for diverticulitis in the United States.
Retrospective database analysis.
The National Inpatient Sample database.
Patients admitted to the hospital for diverticulitis from 2002 to 2007.
Patient characteristics, surgical approach, and mortality were evaluated for elective or emergent admission.
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).
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.