|
Back to 2016 Annual Meeting
20-Year Trends in the Management of Diverticulitis Across New York State, an Analysis of 265,724 Patients
Ryan Lamm*, Steven N. Mathews, 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:
Acute diverticulitis (AD) has contributed to an increasing number of hospital admissions over the past twenty years in the United States. Management of this disease has considerably changed over time with relaxation of previously stringent operative guidelines.
Aim:
This study was conducted to evaluate recent management patterns in acute diverticulitis across demographic populations in New York state.
Methods:
In this retrospective study, 265,724 patients with acute diverticulitis were analyzed from 1995 to 2014 from the New York State-Statewide Planning and Research Cooperative System (SPARCS) database. SPARCS is an administrative database which collects patient-level data on patient characteristics, diagnoses, treatments, and services for every hospital or surgery center encounter in the state of New York. Chi-square test and Welchs t-test were used to compare categorical and continuous variables. Linear trends displaying the likelihood of having emergent surgery over time were examined and compared across age, gender, race/ethnic, and payment subgroups using logistic regression models. Trends were illustrated by the estimated odds ratio along with their 95% confidence intervals.
Results:
From 1995-2014 there was an increase in newly diagnosed diverticulitis patients and hospital admissions related to diverticulitis while the proportion of patients undergoing operative management steadily decreased (31 to 10%, p<0.0001). Over this same time period, emergent surgeries decreased (58 to 47%, p<0.0001) while elective surgeries increased (42 to 53%, p<0.0001) with the odds of having emergency surgery decreasing by 4% annually (OR 0.96 [0.95-0.97], p<0.0001). These linear trends were substantiated across gender, race/ethnic, payment, and most age subgroups. However, patients greater than 80 years old did not show a significant decrease in percentage of emergent surgery over this time period.
Conclusions:
Over the past twenty years in New York state, there has been an increase in the prevalence of diverticulitis diagnoses and hospital admissions. Interestingly, there has been a significant shift toward nonoperative management, in particular at initial presentation as is represented by the decrease in emergent surgeries. The percentage of patients receiving elective surgeries has increased during this time, but still represents a small portion of diverticulitis patients. These trends likely reflect more effective antibiotic treatment as well as changes in management paradigms. Longitudinal outcome analysis would be useful in assessing whether these trends have resulted in superior patient care.
Back to 2016 Annual Meeting
|
