Acute Diverticulitis Outcomes in the Acute Care Surgery Model

Area of Science:

• Surgical outcomes research
• Health services research
• Gastrointestinal surgery

Background:

• The acute care surgery (ACS) model's efficiency is debated, with evidence suggesting it serves sicker, more disadvantaged populations.
• This study evaluates the ACS model's effectiveness in managing diverticulitis compared to traditional care across a state.

Purpose of the Study:

• To compare patient outcomes for diverticulitis management under acute care surgery (ACS) versus traditional care models.
• To assess the impact of the ACS model on patient demographics, disease severity, and clinical outcomes.

Main Methods:

• Utilized the Virginia Health Information administrative database (2008-2015) for adult diverticulitis admissions.
• Compared patient characteristics and outcomes between ACS and traditional care models using logistic regression, adjusting for comorbidities and demographics.

Main Results:

• ACS patients were more likely to be uninsured or on Medicaid and presented with higher rates of comorbidities and complicated diverticulitis.
• Adjusted analysis showed higher complication rates in ACS patients (OR 1.36), but no significant differences in mortality, length of stay, or costs.
• Operative diverticulitis patients showed no outcome differences between ACS and traditional models after adjustment.

Conclusions:

• ACS programs effectively manage complex diverticulitis patients with higher medical needs and socioeconomic challenges.
• Despite increased initial complications, the ACS model provides comparable quality and efficient care to traditional models for operative diverticulitis cases.