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Elective colectomy after acute diverticulitis: an international comparison.
M K-Y Hong1, A R Skandarajah2, M P Joy3
1Department of Surgery (Western Health), The University of Melbourne, Melbourne, Victoria, Australia.
Summary
Elective colectomy rates after acute diverticulitis vary significantly by country, with higher rates in the USA and England compared to Australia. This suggests opportunities to reduce surgical resource utilization by adopting less aggressive approaches.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Health Services Research
Background:
- Routine elective colectomy following acute diverticulitis is frequently performed despite not being recommended.
- Rising healthcare costs necessitate optimization of surgical intervention strategies for acute diverticulitis.
- International comparison of colectomy rates can inform resource utilization and treatment guidelines.
Purpose of the Study:
- To compare the rates of elective colectomy after acute diverticulitis in the USA, England, and Australia.
- To identify variations in surgical management strategies for acute diverticulitis across different healthcare systems.
- To explore potential for optimizing operative intervention for acute diverticulitis.
Main Methods:
- Analysis of an international administrative dataset (2008-2012) for index unplanned admissions due to acute diverticulitis.
- Follow-up data (until 2014) to identify recurrent admissions and subsequent elective colectomies.
- Multivariable analysis to control for patient and disease factors, comparing elective colectomy rates, emergency operative interventions, and recurrence rates.
Main Results:
- A total of 7842 index admissions for acute diverticulitis were identified.
- Elective colectomy rates were 13% (USA), 5.4% (England), and 3.4% (Australia).
- The propensity for elective colectomy was significantly higher in the USA and England compared to Australia, with recurrence rates at 10% across all countries.
Conclusions:
- Significant international disparities exist in elective colectomy rates following acute diverticulitis.
- The USA demonstrates a markedly higher propensity for elective colectomy compared to England and Australia.
- Findings suggest potential for reducing resource utilization through less aggressive surgical management, pending quality of life outcome analysis.
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