Michael A Napolitano1, Andrew D Sparks2, J Alex Randall3, Fred J Brody4, James E Duncan5. 1. Department of Surgery, Washington, D.C. Veterans Affairs Medical Center. 50 Irving St.NW, Suite 2B-100, Washington, DC, 20422, USA; Department of Surgery, George Washington University, 2150 Pennsylvania Ave Suite 6B. Washington, DC, 20037, USA. Electronic address: mnapoli@gwu.edu. 2. Department of Surgery, George Washington University, 2150 Pennsylvania Ave Suite 6B. Washington, DC, 20037, USA. Electronic address: asparks@mfa.gwu.edu. 3. Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Ave, Maywood, IL, 60153, USA. Electronic address: jalexrandall@gmail.com. 4. Department of Surgery, Washington, D.C. Veterans Affairs Medical Center. 50 Irving St.NW, Suite 2B-100, Washington, DC, 20422, USA. Electronic address: fredrick.brody@va.gov. 5. Department of Surgery, Washington, D.C. Veterans Affairs Medical Center. 50 Irving St.NW, Suite 2B-100, Washington, DC, 20422, USA. Electronic address: james.duncan1@va.gov.
Abstract
BACKGROUND: Treatment for diverticular disease has evolved over time. In the United States, there has been a trend towards minimally invasive surgical approaches and fewer postoperative complications, but no study has investigated this subject in the Veterans Health Administration. METHODS: This retrospective review identified patients undergoing elective surgery for diverticular disease from 2004 to 2018. Demographics, comorbidities, operative approach, rates of ostomy creation, and 30-day outcomes were compared. The 15-year time period was divided into 3-year increments to assess changes over time. RESULTS: 4198 patients were identified. Complication rate decreased significantly over time (28.1%-15.7%, p < 0.001), as did infectious complications (21.5-6.3%, p < 0.001). Median hospital length-of-stay decreased from 7 to 5 days (p < 0.001). Rates of laparoscopic surgery increased over time (17.7%-48.1%, p < 0.001). CONCLUSIONS: Increased utilization of laparoscopy in veterans undergoing elective surgery for diverticular disease coincided with fewer complications and a shorter length-of-stay. These trends mirror outcomes reported in non-veterans. Published by Elsevier Inc.
BACKGROUND: Treatment for diverticular disease has evolved over time. In the United States, there has been a trend towards minimally invasive surgical approaches and fewer postoperative complications, but no study has investigated this subject in the Veterans Health Administration. METHODS: This retrospective review identified patients undergoing elective surgery for diverticular disease from 2004 to 2018. Demographics, comorbidities, operative approach, rates of ostomy creation, and 30-day outcomes were compared. The 15-year time period was divided into 3-year increments to assess changes over time. RESULTS: 4198 patients were identified. Complication rate decreased significantly over time (28.1%-15.7%, p < 0.001), as did infectious complications (21.5-6.3%, p < 0.001). Median hospital length-of-stay decreased from 7 to 5 days (p < 0.001). Rates of laparoscopic surgery increased over time (17.7%-48.1%, p < 0.001). CONCLUSIONS: Increased utilization of laparoscopy in veterans undergoing elective surgery for diverticular disease coincided with fewer complications and a shorter length-of-stay. These trends mirror outcomes reported in non-veterans. Published by Elsevier Inc.