Evolving practice patterns in the management of acute colonic diverticulitis: a population-based analysis

Area of Science:

• Gastroenterology
• Surgical Innovation
• Health Services Research

Background:

• Acute diverticulitis management is evolving with increasing support for percutaneous abscess drainage, laparoscopy, and primary anastomosis.
• Understanding practice evolution and its impact on clinical outcomes is crucial for optimizing patient care.

Purpose of the Study:

• To evaluate changes in treatment strategies for acute diverticulitis over a decade (2002-2012).
• To determine the effects of these evolving practices on patient outcomes, including mortality and length of stay.

Main Methods:

• Population-based retrospective cohort study utilizing administrative discharge data from Ontario, Canada.
• Analysis of 18,543 first-episode acute diverticulitis hospitalizations between 2002 and 2012.
• Cochran-Armitage test for trends and multivariable logistic regression with generalized estimating equations were used to assess changes in treatment and outcomes.

Main Results:

• Despite an increase in complicated diverticulitis cases (32% to 38%), urgent operations decreased (28% to 16%).
• Percutaneous drainage use rose (1.9% to 3.3%), and laparoscopic surgery increased among those operated on (9% to 18%).
• In-hospital mortality declined (2.7% to 1.9%), and median length of stay shortened (5 to 3 days).

Conclusions:

• Nonoperative and minimally invasive strategies are increasingly used for acute diverticulitis.
• The Hartmann procedure remains a common urgent surgical approach, though its use did not change significantly.
• Improvements in mortality and length of stay were observed, potentially linked to evolving treatment strategies.