Temporal changes in the management of diverticulitis.
OBJECTIVE
This study was designed to evaluate temporal trends in the use and type of operative and non-operative interventions in the management of diverticulitis.


METHODS
A retrospective cohort using a statewide administrative database was used to identify all patients hospitalized for diverticulitis in the state of Washington (1987-2001). Poisson and logistic regression were used to calculate changes in the frequency of hospitalization, operative and percutaneous interventions, and colostomy over time.


RESULTS
Of the 25,058 patients hospitalized non-electively with diverticulitis (mean age 69 +/- 16, 60% female) there were only minimal changes in the frequency of admissions over time (0.006% increase per year-IRR 1.00006 95% CI 1.00004, 1.00008). The odds of an emergency colectomy at initial hospitalization decreased by 2% each year (OR 0.98 95% CI 0.98, 0.99) whereas the odds of percutaneous abscess drainage increased 7% per year (OR 1.07 95% CI 1.05, 1.1). Among patients undergoing percutaneous drainage, the odds of operative interventions decreased by 9% compared to patients who did not have a percutaneous intervention (OR 0.91 95% CI 0.87, 0.94). The proportion of patients undergoing colostomy during emergency operations remained essentially stable over time (range 49-61%), as did the proportion of patients undergoing prophylactic colectomy after initial non-surgical management (approximately 10%).


CONCLUSIONS
There was a minimal increase in the frequency of diverticulitis admissions over time. A rise in percutaneous drainage procedures was associated with a decrease in emergency operative interventions. The proportion of patients undergoing colostomy remained stable, and there does not seem to be a significant increase in the use of one-stage procedures for diverticulitis.
Salem
Leon
L
Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA.
Anaya
Daniel A
DA
Flum
David R
DR
D000368:Aged; D003082:Colectomy / Q000706:statistics & numerical data*; D003125:Colostomy / Q000706:statistics & numerical data*; D016208:Databases, Factual; D004239:Diverticulitis, Colonic / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014861:Washington / Q000453:epidemiology