title: Subspecialist emergency management of diverticulitis is associated with reduced mortality and fewer stomas.
abstract: OBJECTIVE
  The aim of the study was to compare outcomes for emergency management of diverticulitis before and after the creation of a regional subspecialist colorectal unit.
  
  
  METHODS
  We retrieved data on all emergency admissions for diverticulitis from the regional surgical audit database and compared results before (January 1998 to August 2002) and after (August 2002 to December 2008) establishment of the subspecialist colorectal surgery unit in August 2002. Additional data were retrieved from electronic patient records. The primary outcome measures were mortality and rate of primary anastomosis following resection.
  
  
  RESULTS
  There were 879 patients before and 1280 patients after subspecialization. Nonoperative management was undertaken in approximately 80% of cases. Total mortality fell from 3.3 to 1.5% (P = 0.008), attributable to reduced operative mortality (9.6 to 4.2%; P = 0.019). The primary anastomosis rate for all left colon resections increased from 50.3 to 77.9%; P < 0.0001. Stoma formation of any type fell from 46.6 to 27.7%; P < 0001).
  
  
  CONCLUSIONS
  Emergency management of diverticulitis by subspecialist colorectal surgeons is associated with low overall and operative mortality whilst safely achieving high rates of primary anastomosis.
authors.affiliation: Western General Hospital, Edinburgh University of Edinburgh, Edinburgh, UK. stephenaboyce@gmail.com
authors.forename: S A
authors.initials: SA
authors.lastname: Boyce
authors.forename: D C C
authors.initials: DC
authors.lastname: Bartolo
authors.forename: H M
authors.initials: HM
authors.lastname: Paterson
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000401:mortality / Q000706:statistics & numerical data; D003082:Colectomy / Q000401:mortality / Q000706:statistics & numerical data; D003107:Colorectal Surgery; D004239:Diverticulitis, Colonic / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D004630:Emergencies; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000401:mortality / Q000706:statistics & numerical data; D007082:Ileum / Q000601:surgery*; D008297:Male; D012007:Rectum / Q000601:surgery*; D012606:Scotland / Q000453:epidemiology; D013038:Specialization