title: International Variation in Emergency Operation Rates for Acute Diverticulitis: Insights into Healthcare Value.
abstract: International comparison of outcomes of surgical diseases has become a global focus because of widespread concern over surgical quality, rising costs and the value of healthcare. Acute diverticulitis is a common disease potentially amenable to optimization of strategies for operative intervention. The aim was to compare the emergency operative intervention rates for acute diverticulitis in USA, England and Australia.
  
  
  
  Unplanned admissions for acute diverticulitis were found from an international administrative dataset between 2008 and 2014 for hospitals in USA, England and Australia. The primary outcome measured was emergency operative intervention rate. Secondary outcomes included inpatient mortality and percutaneous drainage rate. Multivariable analysis was performed after development of a weighted comorbidity scoring system.
  
  
  
  There were 15,150 unplanned admissions for acute diverticulitis. The emergency operative intervention rates were 16, 13 and 10% for USA, England and Australia. The percutaneous drainage rate was highest in USA at 10%, while the mortality rate was highest in England at 2.8%. The propensity for emergency operative intervention was higher in USA (OR 1.45, p < 0.001) and England (OR 1.49, p < 0.001) than in Australia. The risk of 7-day mortality was higher in England than in Australia (OR 2.79, p < 0.001). Percutaneous drainage was associated with reduced 7-day mortality risk.
  
  
  
  Australia has a lower propensity for emergency operative intervention, while England has a greater risk of mortality for acute diverticulitis. International variations raise the issue of healthcare value in terms of differing resource use and outcomes.
authors.affiliation: Department of Surgery, The University of Melbourne, Melbourne, Australia. mkyhong@gmail.com.|Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Australia. mkyhong@gmail.com.
authors.forename: Michael K Y
authors.initials: MKY
authors.lastname: Hong
authors.affiliation: Department of Surgery, The University of Melbourne, Melbourne, Australia.|Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Anita R
authors.initials: AR
authors.lastname: Skandarajah
authors.affiliation: Dr Foster Intelligence, London, UK.
authors.forename: Rose D
authors.initials: RD
authors.lastname: Higgins
authors.affiliation: Department of Surgery, Imperial College, London, UK.
authors.forename: Omar D
authors.initials: OD
authors.lastname: Faiz
authors.affiliation: Department of Surgery, The University of Melbourne, Melbourne, Australia.|Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Ian P
authors.initials: IP
authors.lastname: Hayes
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D004238:Diverticulitis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004322:Drainage / Q000706:statistics & numerical data; D004630:Emergencies; D004739:England / Q000453:epidemiology; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology