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Factors Associated With Repeated Health Resource Utilization in Patients With Diverticulitis
Steven N. Mathews*, Ryan Lamm, Jie Yang, Lijuan Kang, Dana A. Telem, Aurora Pryor, Mark A. Talamini, Jill C. Genua
Surgery, Stony Brook University School of Medicine, Stony Brook, NY
Background:
Treatment of diverticulitis has shifted towards non-operative management. One possible unintended consequence may be increased hospitalizations secondary to repeated attacks. The impact on health resource utilization remains unclear.
Aim:
The aim of this study was to risk-assess patients with diverticulitis that required multiple hospitalizations in order to identify high utilizers.
Methods:
A total of 265,724 patients with diverticulitis were identified from 1995 to 2014 from the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patients with a primary diagnosis of diverticulitis that had ≥ 2 hospital admissions were stratified across age group, ethnicity, gender, insurance status, geographic location, comorbidities and use of surgical intervention. Multivariable logistic regression analysis was performed to estimate odds ratios and 95% confidence intervals by comparing patients in each group after adjusting for other possible confounding factors.
Results:
Of the 265,724 patients, 76% were managed as inpatients and 23% as outpatients. Patients were followed longitudinally from their first identified admission until 2014 (range 0 to 20 years). The number of hospital admissions ranged from 1-115. The mean and median number of admissions was one. Of those treated as inpatients, 160, 531 (79%) required one admission, 30,114 (15%) required 2 admissions, and 12,736 (6%) required > 2 admissions. For patients with ≥ 2 admissions 52% went on to have surgery with an average number of admissions before surgery of 1.34. Risk factors for multiple admissions included: younger age, white race, commercial insurance, obesity, hypertension, pulmonary disease, hypothyroidism, rheumatoid arthritis, substance abuse, and depression (all p-values < 0.05). Assessing patients with multiple admissions demonstrated that factors more likely associated with surgery included: younger age, white race, male gender, and commercial insurance (all p-values < 0.0001). Conversely, factors less likely associated with surgery in patients with multiple admissions included: older age, black race, and female gender (all p-values < 0.0001).
Conclusions
One in five patients with diverticulitis will require two or more admissions. Numerous risk factors for these frequent utilizers were identified. Of these patients, only half will go on to have surgery. Frequency of admission should be considered a possible indicator for operative intervention. Studies detailing patient outcomes, satisfaction and the economic burden of repeated hospitalizations versus operative intervention are underway.
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