All-Cause Hospitalisation After Endoscopic Diagnosis of Diverticular Disease: A Prospective Real-World Cohort Study

Background: Diverticular disease (DD) represents an important clinical and healthcare burden, particularly in ageing populations. The relationship between the Diverticular Inflammation and Complication Assessment (DICA) classification and overall healthcare utilisation remains insufficiently defined. The aim of our study was to assess predictors and causes of all-cause hospitalisation during follow-up in patients with DD evaluated using the DICA classification. Methods: This prospective observational study included consecutive ambulatory patients with DD evaluated endoscopically in a tertiary gastroenterology centre during a 6-month period. Patients were prospectively followed for 3 years. Demographic and clinical characteristics, DICA classification, treatment, diverticulitis episodes and hospital admissions were recorded. The primary endpoint was any all-cause hospitalisation during follow-up. Results: Among 243 patients, all-cause hospitalisation occurred in 101 patients (41.6%), while recurrent hospitalisation occurred in 37 (15.2%). The cumulative hospitalisation burden reached 1607 hospital days. Acute diverticulitis occurred in 15 patients (6.2%), with only one diverticulitis-related hospitalisation, and no diverticular disease-related surgery was recorded. In multivariable analysis, age (OR 1.49; 95% CI 1.06-2.11; p = 0.023) and respiratory comorbidity (OR 5.31; 95% CI 1.49-18.88; p = 0.010) were independently associated with hospitalisation, whereas DICA ≥ 2 was not. However, the estimate for respiratory comorbidity should be interpreted cautiously because it was based on only 14 affected patients and had a wide confidence interval. Conclusions: Although all-cause hospitalisation was common and driven predominantly by age and comorbidity rather than diverticular disease severity, diverticular disease-specific outcomes were generally favourable in this stable ambulatory cohort.