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CONTEMPORARY EMERGENCY MANAGEMENT AND 1-YEAR OUTCOMES OF COLONIC DIVERTICULITIS: A POPULATION-BASED COHORT STUDY
Teagan Telesnicki
*1,2, Therese Stukel
3, Anthony de Buck van Overstraeten
1,2,4, Charles De Mestral
1,2,5, David Gomez
1,2,61University of Toronto Department of Surgery, Toronto, ON, Canada; 2Institute for Health Policy, Management and Evaluation, University of Torotno, Toronto, ON, Canada; 3ICES, Toronto, ON, Canada; 4Department of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada; 5Division of Vascular Surgery, Unity Health, Toronto, ON, Canada; 6Division of General Surgery, Unity Health, Toronto, ON, Canada
Background: In an era of increasing non-operative management of an index episode of diverticulitis, contemporary estimates of disease recurrence and long-term risk of urgent and scheduled surgery are needed. This study aimed to describe contemporary outcomes on index hospitalization and 1-year from index discharge in patients with diverticulitis.
Methods: This population-based retrospective cohort study was inclusive of all adult residents of Ontario, Canada presenting to the emergency department (ED) with diverticulitis between January 1, 2017 - February 28, 2019 (pre-COVID-19) and March 1, 2020 - March 3, 2022 (COVID-19 period). The risk of urgent surgery, percutaneous drainage and mortality during index hospitalization are reported, and COVID-19 periods were compared using Poisson generalized estimating equation models. Following index presentation discharge (from the ED or hospital with an intact colon), the cumulative incidence of unplanned hospitalization, urgent surgery and scheduled surgery were calculated at 30-days and 1-year, accounting for competing risks, and COVID-19 time periods were compared through multivariable time-to-event analysis.
Results: Of 24,759 patients identified, 6,263 (25%) were hospitalized on index presentation, of which 555 (9%) underwent surgery and 329 (5%) percutaneous drainage. There was no association between COVID-19 time-period and the risk of surgery, percutaneous drainage, or mortality (Figure 1). The cumulative incidence of unplanned hospitalization, urgent surgery and scheduled surgery were 2.2% (95% CI 2.1-2.4), 0.6% (95% CI 0.5-0.7%) and 0.06% (95% CI 0.03-0.09) at 30-days, and 7.0% (95% CI 6.7-7.3%), 1.3% (95% CI 1.2-1.5%) and 1.5 (95% CI 1.3-1.6) at 1-year. Relative to pre-COVID-19, the COVID-19 period was associated with a decreased adjusted hazard rate (aHR) of scheduled surgery (aHR 0.7, 95%CI 0.6-0.9), with no difference in the aHR of unplanned hospitalization or urgent surgery (Figure 2). Among a subgroup of patients undergoing percutaneous drain insertion on index hospitalization, the cumulative incidence of unplanned hospitalization, urgent surgery and scheduled surgery at 1-year were 17.8 (95% CI 11.9 – 24.7), 4.4% (95% CI 1.8 – 8.9), 7.4% (95% CI 3.8 – 12.7).
Conclusions: At 1-year from index presentation discharge, the incidence of recurrent diverticulitis requiring hospitalization was low, with a small minority of patients undergoing urgent or scheduled surgery, despite high rates of index non-operative management. Among a subgroup of patients undergoing index percutaneous drainage, rates of recurrence were higher.
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