T. Galbreath1, B. Palachick1, T. Bell1, R. Grim1, V. Ahuja1 1York Hospital,Surgery,York, PA, USA
Introduction: Though classically an operative disease, complicated diverticulitis has started to trend towards nonoperative management, which is primarily achieved with percutaneous drainage. The aim of our study was to evaluate the trends and discover its effects on management and whether an aging population is spared from operations.
Methods: 158,251 cases from HCUP-NIS discharge data (2007-2011) were collected with primary admission of complicated (abscess, ICD-9 569.5 or perforated 569.83) diverticulitis (ICD-9 562.11 or 562.13). Patients were assessed for percutaneous drainage (ICD9 54.91). Intervention groups were non-operative, non-operative with percutaneous drainage or operative (all other surgeries). Age of patients was evaluated by two groups (younger 18-59 and older 60+). Exclusion criteria were: < 18 years of age, malignancy, and inflammatory bowel disease. Descriptive, x2, and test of proportion statistics were used to evaluate incidence rate of admission, and demographic changes.
Results: Complicated diverticulitis hospitalizations have increased from 19 to 21.5% from 2007 to 2011 (p<.001). The majority of patients were younger (55.5%), however the highest rate increase was in older patients with complicated diverticulitis (2.8%, p<.001). The abscess rate increased from 91.8% to 98.6%, while at the same time perforations decreased from 10.6 to 1.9 (all p<.001). Patients were managed non-operatively (42.3%), non-operatively without percutaneous drainage (13.5%) and with operative intervention (44.2%). However, there was an increase in non-operative intervention (4.1%) and non-operative percutaneous drainage (3.9%) and a decrease in operative treatment (-8.0%) over the study time period (Figure 1, all p<.001). By age, in older patients there was an increasing trend in operative treatment (4.2%, p = 0.825). While the younger group saw a significant increase in non-operative percutaneous drainage (0.4%, p<.001) over the study time period.
Conclusions: Our findings do support the rising trend in overall hospitalizations with nonoperative management and use of percutaneous drainage for abscess. However the elderly are presenting with an increasing rate of complicated diverticulitis requiring operative intervention. It is possible the nonoperative management in the younger population is increasing the need for future hospitalizations and operative management as they age. Further studies could aim at determining long-term outcomes of elective colectomies after effective nonoperative management in the younger population and if this reduces emergent operations in the elderly.