title: Out-Patient Management of Mild or Uncomplicated Diverticulitis: A Systematic Review.
abstract: BACKGROUND
  Management of diverticular disease has undergone a paradigm shift, with movement towards a less invasive management strategy. In keeping with this, outpatient management of uncomplicated diverticulitis (UD) has been advocated in several studies, but concerns still remain regarding the safety of this practice.
  
  
  OBJECTIVE
  To assess outcomes of out-patient management of acute UD.
  
  
  METHODS
  A comprehensive search for published studies using the search terms 'uncomplicated diverticulitis', 'mild diverticulitis' and 'out-patient' was performed. The primary outcomes were failure of medical treatment. Secondary outcomes were recurrence rate at follow up and medical cost savings.
  
  
  RESULTS
  The search yielded 192 publications. Of these, 10 studies met the inclusion criteria including 1 randomized controlled trial, 6 clinical controlled trials and 3 case series. There was no difference in failure rates of medical treatment (6.5 vs. 4.6%, p = 0.32) or in recurrence rates (13.0 vs. 12.1%, p = 0.81) between those receiving ambulatory care and in-patient care for UD. Ambulatory treatment is associated with an estimated daily cost savings of between 600 and 1,900 euros per patient treated. Meta-analysis of data was not possible due to heterogeneity in study designs and inclusion criteria.
  
  
  CONCLUSIONS
  Ambulatory management of acute UD is reasonable in selected patients.
authors.affiliation: Department of Surgery, Wexford General Hospital, Wexford, Ireland.
authors.forename: Ishwarya
authors.initials: I
authors.lastname: Balasubramanian
authors.forename: Christina
authors.initials: C
authors.lastname: Fleming
authors.forename: Helen M
authors.initials: HM
authors.lastname: Mohan
authors.forename: Karl
authors.initials: K
authors.lastname: Schmidt
authors.forename: Eva
authors.initials: E
authors.lastname: Haglind
authors.forename: Des C
authors.initials: DC
authors.lastname: Winter
mesh_terms: D000208:Acute Disease; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D000700:Analgesics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017046:Cost Savings; D004032:Diet; D004238:Diverticulitis / Q000191:economics / Q000628:therapy*; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D012008:Recurrence; D012720:Severity of Illness Index; D017211:Treatment Failure
chemical_list: D000700:Analgesics; D000900:Anti-Bacterial Agents