Significant Reduction in Length of Stay Through the Introduction of an Outpatient Management Protocol for...

Acute diverticulitis is a common presentation to hospital emergency departments (ED) and a significant burden on healthcare resources worldwide. Multiple studies have shown that outpatient management of uncomplicated diverticulitis is safe, yet many patients are still treated in the hospital. We instituted a protocol for the outpatient treatment at our institution, focusing on safety and healthcare costs.

From February 2021, the new outpatient management of uncomplicated left-sided diverticulitis protocol was implemented; all patients that presented through the ED with a computed tomography diagnosis of uncomplicated left-sided diverticulitis were managed as an outpatient with oral antibiotics unless they met exclusion criteria (insulin-dependent diabetes, immunosuppression, active malignancy, pregnancy, or inflammatory bowel disease). This was compared to a historical comparison immediately prior. The primary outcome of interest was length of stay (LOS) in hours.

There were 106 patients in each group. The LOS in the outpatient group was 29.7 h less than in the inpatient group (95% CI 21.9-37.5; p < 0.001). Patients with co-morbidities stayed significantly longer, with ASA 3 and 4 more than 17 h (53 h vs. 35 h, p < 0.001), and a high CCI (score ≥ 5) more than 32 h (67 h vs. 35 h, p < 0.001). The odds of readmission were not significantly different between the outpatient and inpatient cohorts (OR 1.49, 95% CI 0.54-4.07, p = 0.438).

Outpatient management for uncomplicated left-sided diverticulitis results in a significant reduction of LOS and does not result in an increase in readmissions.