Vlad V Simianu1, Lisa L Strate, Richard P Billingham, Alessandro Fichera, Scott R Steele, Richard C Thirlby, David R Flum. 1. *Department of Surgery, University of Washington, Seattle, WA †Department of Medicine, University of Washington, Seattle, WA ‡Department of Surgery, Swedish Medical Center, Seattle, WA §Department of Surgery, Madigan Army Medical Center, Tacoma, WA ¶Department of Surgery, Virginia Mason Medical Center, Seattle, WA.
Abstract
OBJECTIVE: To determine the impact of elective colectomy on emergency diverticulitis surgery at the population level. BACKGROUND: Current recommendations suggest avoiding elective colon resection for uncomplicated diverticulitis because of uncertain effectiveness at reducing recurrence and emergency surgery. The influence of these recommendations on use of elective colectomy or rates of emergency surgery remains undetermined. METHODS: A retrospective cohort study using a statewide hospital discharge database identified all patients admitted for diverticulitis in Washington State (1987-2012). Sex- and age-adjusted rates (standardized to the 2000 state census) of admissions, elective and emergency/urgent surgical and percutaneous interventions for diverticulitis were calculated and temporal changes assessed. RESULTS: A total of 84,313 patients (mean age 63.3 years and 58.9% female) were hospitalized for diverticulitis (72.2% emergent/urgent). Elective colectomy increased from 7.9 to 17.2 per 100,000 people (P < 0.001), rising fastest since 2000. Emergency/urgent colectomy increased from 7.1 to 10.2 per 100,000 (P < 0.001), nonelective percutaneous interventions increased from 0.1 to 3.7 per 100,000 (P = 0.04) and the frequency of emergency/urgent admissions (with or without a resection) increased from 34.0 to 85.0 per 100,000 (P < 0.001). In 2012, 47.5% of elective resections were performed laparoscopically compared to 17.5% in 2008 (when the code was introduced). CONCLUSIONS: The elective colectomy rate for diverticulitis more than doubled, without a decrease in emergency surgery, percutaneous interventions, or admissions for diverticulitis. This may reflect changes in thresholds for elective surgery and/or an increase in the frequency or severity of the disease. These trends do not support the practice of elective colectomy to prevent emergency surgery.
OBJECTIVE: To determine the impact of elective colectomy on emergency diverticulitis surgery at the population level. BACKGROUND: Current recommendations suggest avoiding elective colon resection for uncomplicated diverticulitis because of uncertain effectiveness at reducing recurrence and emergency surgery. The influence of these recommendations on use of elective colectomy or rates of emergency surgery remains undetermined. METHODS: A retrospective cohort study using a statewide hospital discharge database identified all patients admitted for diverticulitis in Washington State (1987-2012). Sex- and age-adjusted rates (standardized to the 2000 state census) of admissions, elective and emergency/urgent surgical and percutaneous interventions for diverticulitis were calculated and temporal changes assessed. RESULTS: A total of 84,313 patients (mean age 63.3 years and 58.9% female) were hospitalized for diverticulitis (72.2% emergent/urgent). Elective colectomy increased from 7.9 to 17.2 per 100,000 people (P < 0.001), rising fastest since 2000. Emergency/urgent colectomy increased from 7.1 to 10.2 per 100,000 (P < 0.001), nonelective percutaneous interventions increased from 0.1 to 3.7 per 100,000 (P = 0.04) and the frequency of emergency/urgent admissions (with or without a resection) increased from 34.0 to 85.0 per 100,000 (P < 0.001). In 2012, 47.5% of elective resections were performed laparoscopically compared to 17.5% in 2008 (when the code was introduced). CONCLUSIONS: The elective colectomy rate for diverticulitis more than doubled, without a decrease in emergency surgery, percutaneous interventions, or admissions for diverticulitis. This may reflect changes in thresholds for elective surgery and/or an increase in the frequency or severity of the disease. These trends do not support the practice of elective colectomy to prevent emergency surgery.
Authors: Steve Kwon; Michael Florence; Peter Grigas; Marc Horton; Karen Horvath; Morrie Johnson; Gregory Jurkovich; Wendy Klamp; Kristin Peterson; Terence Quigley; William Raum; Terry Rogers; Richard Thirlby; Ellen T Farrokhi; David R Flum Journal: Surgery Date: 2011-11-30 Impact factor: 3.982
Authors: Steve Kwon; Richard Billingham; Ellen Farrokhi; Michael Florence; Daniel Herzig; Karen Horvath; Terry Rogers; Scott Steele; Rebecca Symons; Richard Thirlby; Mark Whiteford; David R Flum Journal: J Am Coll Surg Date: 2012-04-24 Impact factor: 6.113
Authors: Jens Christian Andersen; Lars Bundgaard; Henrik Elbrønd; Søren Laurberg; Line Rosell Walker; Jens Støvring Journal: Dan Med J Date: 2012-05 Impact factor: 1.240
Authors: Bryan J M van de Wall; Werner A Draaisma; Esther C J Consten; Yolanda van der Graaf; Marten H Otten; G Ardine de Wit; Henk F van Stel; Michael F Gerhards; Marinus J Wiezer; Huib A Cense; Hein B A C Stockmann; Jeroen W A Leijtens; David D E Zimmerman; Eric Belgers; Bart A van Wagensveld; Eric D J A Sonneveld; Hubert A Prins; Peter P L O Coene; Tom M Karsten; Joost M Klaase; Markwin G Statius Muller; Rogier M P H Crolla; Ivo A M J Broeders Journal: BMC Surg Date: 2010-08-06 Impact factor: 2.102
Authors: Antonio M Lacy; Juan C García-Valdecasas; Salvadora Delgado; Antoni Castells; Pilar Taurá; Josep M Piqué; Josep Visa Journal: Lancet Date: 2002-06-29 Impact factor: 79.321
Authors: Anne F Peery; Evan S Dellon; Jennifer Lund; Seth D Crockett; Christopher E McGowan; William J Bulsiewicz; Lisa M Gangarosa; Michelle T Thiny; Karyn Stizenberg; Douglas R Morgan; Yehuda Ringel; Hannah P Kim; Marco Dacosta DiBonaventura; Charlotte F Carroll; Jeffery K Allen; Suzanne F Cook; Robert S Sandler; Michael D Kappelman; Nicholas J Shaheen Journal: Gastroenterology Date: 2012-08-08 Impact factor: 22.682
Authors: Heidi Nelson; Daniel J Sargent; H Sam Wieand; James Fleshman; Mehran Anvari; Steven J Stryker; Robert W Beart; Michael Hellinger; Richard Flanagan; Walter Peters; David Ota Journal: N Engl J Med Date: 2004-05-13 Impact factor: 91.245
Authors: Marco von Strauss Und Torney; Giusi Moffa; Max Kaech; Fabian Haak; Stefan Riss; Elisabeth Deutschmann; Heiner C Bucher; Christoph Kettelhack; Hugh M Paterson Journal: JAMA Surg Date: 2020-07-01 Impact factor: 14.766
Authors: Vlad V Simianu; Alessandro Fichera; Amir L Bastawrous; Giana H Davidson; Michael G Florence; Richard C Thirlby; David R Flum Journal: JAMA Surg Date: 2016-07-01 Impact factor: 14.766
Authors: Steven N Mathews; Ryan Lamm; Jie Yang; Lijuan Kang; Dana Telem; Aurora D Pryor; Mark Talamini; Jill Genua Journal: J Gastrointest Surg Date: 2016-09-09 Impact factor: 3.452
Authors: Charles E Gaber; Alan C Kinlaw; Jessie K Edwards; Jennifer L Lund; Til Stürmer; Sharon Peacock Hinton; Virginia Pate; Luther A Bartelt; Robert S Sandler; Anne F Peery Journal: Ann Intern Med Date: 2021-02-23 Impact factor: 51.598