B. Zangbar1, S. Imtiaz1, V. Roudnitsky1, L. Dresner1, H. Talus1, A. Schwartzman1, F. Serafini1, R. Gruessner1 1State University Of New York Downstate Medical Center,Surgery,Brooklyn, NY, USA
Introduction: Diverticular disease is among the most prevalent diseases in United States and imposes a vast healthcare burden to population. Treatment of diverticulitis has evolved over time with reportedly increasing primary anastomosis and non-operative treatment. The aim of our study was to assess these changes in patterns of practice over an 8 year period using a national database.
Methods: We used the 2004 to 2011 nationwide inpatient sample (NIS) database to analyze the care received by 412,163 patients admitted with acute diverticulitis, and 47,574 patients operated for diverticulitis. Patient’s with Left hemicolectomy, Colostomy, Ileostomy, and percutaneous abscess drainage were identified and Jonckheere-Terpstra trend analysis and logistic regression analysis was used.
Results: Overall there was an increase in rate of admission for acute diverticulitis from 2004 to 2011. There was a decrease in rate of operations for diverticulitis from 5,832 (12.5%) to 5,823 (10.2%) per year during the same time period. The rate of primary anastomosis is decreased from 2,306 (5.0%) in 2004 to 1,660 (2.9%) in 2011 while patients admitted with acute diverticular disease were relatively younger during the same time period (64±16 in 2004 vs 63±16 in 2011, p=0.001). Gender, Race, and comorbidities was unchanged. Mortality during hospitalization decreased from 1.8% in 2004 to 1.5% in 2011.
Conclusion: Our study shows that non-operative management is clearly increasing over time with one main exception. In those that did receive operations there is a significantly decreased rate of primary anastomosis. The cause of this change, contrary to the prior trend, is unknown. Further research is needed to investigate the role of non-operative management and more selective operative management for primary anastomosis.