Contemporary emergency management and 1-year outcomes of colonic diverticulitis: a population-based cohort study

This study aimed to describe contemporary outcomes on index hospitalization and 1-year outcomes from index discharge in patients with diverticulitis.

This population-based retrospective cohort study included adult residents of Ontario, Canada, who presented to the emergency department (ED) with diverticulitis (January 2017 to March 2022). For individuals hospitalized at the time of index ED presentation, the risks of urgent surgery, percutaneous drainage, and mortality were reported. After index presentation discharge (from the ED or hospital with an intact colon), the cumulative incidences of unplanned hospitalization, urgent surgery, and scheduled surgery were reported at 30 days and 1 year, accounting for competing risks.

Of 24,759 patients presenting to the ED with diverticulitis, 6263 (25%) were hospitalized, and 5379 (23%) required no intervention. However, a minority of patients required surgery (555 [2.2%]) and percutaneous drainage (329 [1.3%]). After index presentation discharge, the cumulative incidences of unplanned hospitalization, urgent surgery, and scheduled surgery were 2.00% (95% CI, 2.10%-2.40%), 0.60% (95% CI, 0.50%-0.70%), and 0.06% (95% CI, 0.03%-0.09%) at 30 days and 7.00% (95% CI, 6.70%-7.30%), 1.30% (95% CI, 1.20%-1.50%), and 1.50% (95% CI, 1.30%-1.60%) at 1 year, respectively. People managed with percutaneous drainage at index presentation were at higher 1-year risk: 44% (95% CI, 29%-39%) unplanned hospitalization and 11% (95% CI, 8%-14%) urgent surgery.

For most patients, the disease course 1 year from index discharge remains benign, with only a small minority of patients requiring hospitalization or surgery. These outcome estimates can guide patient counseling, including the appropriateness of scheduled colectomy for diverticulitis.