Recent Trends in Diverticulitis Management in the United States
Diverticulitis is increasingly managed with laparoscopic techniques for elective operations and primary anastomosis for urgent operations, according to a new study published in the April issue of the Archives of Surgery.
Diverticulitis is swelling (inflammation) of an abnormal pouch (diverticulum) in the intestinal wall. These pouches are usually found in the large intestine (colon). The presence of the pouches themselves is called diverticulosis. Diverticulosis is found in more than half of Americans over age 60. Only a small percentage of these people will develop the complication of diverticulitis.
Michael J. Stamos, MD, University of California, Irvine, Division of Colon and Rectal Surgery,and colleagues sought to demonstrate the recent trends of admission and surgical management for diverticulitis in the United States using a retrospective analysis of the Nationwide Inpatient Sample (NIS) database from 2002 until 2007.
To identify hospitalizations resulting from diverticulitis, all discharges with International Classification of Diseases, (ICD) diagnosis codes 562.11 and 562.13 (diverticulitis with and without mention of hemorrhage) as the first diagnosis from 2002 to 2007 were selected. These patients were then divided into emergent and elective groups based on their admission type.
Type of surgical procedure was identified using ICD-9 procedure codes: resection (sigmoidectomy or anterior resection) with primary anastomosis (with or without diverting ileostomy) and resection with colostomy only. Because there was no distinct ICD-9 procedure code for laparoscopic colectomy during these years, the researchers identified procedures that were done laparoscopically by identifying additional ICD-9 procedure codes for diagnostic laparoscopy or laparoscopic lysis of adhesion in combination with open procedure codes.
Patient characteristics of interest included age, sex, and race/ethnicity. Based on the incidence of diverticulitis, age was divided into 3 groups (70 years). Other data of interest included LOS and in-hospital mortality.
The researchers identified a total of 1,073,397 patients admitted with diverticulitis (emergent: 78.3%, elective: 21.7%) during 2002 to 2007.