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Risk of Emergency Surgery or Death After Initial Nonoperative Management of Complicated Diverticulitis in Scotland and Switzerland.

Published on May 13, 2020in JAMA Surgery10.668
· DOI :10.1001/JAMASURG.2020.0757
Marco von Strauss und Torney (Western General Hospital), Giusi Moffa3
Estimated H-index: 3
(University of Basel)
+ 6 AuthorsHugh Paterson15
Estimated H-index: 15
(Western General Hospital)
Abstract
Importance National guidelines on interval resection for prevention of recurrence after complicated diverticulitis are inconsistent. Although US and German guidelines favor interval colonic resection to prevent a perceived high risk of recurrence, UK guidelines do not. Objectives To investigate patient management and outcomes after an index inpatient episode of nonoperatively managed complicated diverticulitis in Switzerland and Scotland and determine whether interval resection was associated with the rate of disease-specific emergency surgery or death in either country. Design, Setting, and Participants This secondary analysis of anonymized complete national inpatient data sets included all patients with an inpatient episode of successfully nonoperatively managed complicated diverticulitis in Switzerland and Scotland from January 1, 2005, to December 31, 2015. The 2 countries have contrasting health care systems: Switzerland is insurance funded, while Scotland is state funded. Statistical analysis was conducted from February 1, 2018, to October 17, 2019. Main Outcomes and Measures The primary end point defined a priori before the analysis was adverse outcome, defined as any disease-specific emergency surgical intervention or inpatient death after the initial successful nonsurgical inpatient management of an episode of complicated diverticulitis, including complications from interval elective surgery. Results The study cohort comprised 13 861 inpatients in Switzerland (6967 women) and 5129 inpatients in Scotland (2804 women) with an index episode of complicated acute diverticulitis managed nonoperatively. The primary end point was observed in 698 Swiss patients (5.0%) and 255 Scottish patients (5.0%) (odds ratio, 0.98; 95% CI, 0.81-1.19). Elective interval colonic resection was undertaken in 3280 Swiss patients (23.7%; median follow-up, 53 months [interquartile range, 24-90 months]) and 231 Scottish patients (4.5%; median follow-up, 57 months [interquartile range, 27-91 months]). Death after urgent readmission for recurrent diverticulitis occurred in 104 patients (0.8%) in Switzerland and 65 patients (1.3%) in Scotland. None of the investigated confounders had a significant association with the outcome apart from comorbidity. Conclusions and Relevance This study found no difference in the rate of adverse outcome (emergency surgery and/or inpatient death) despite a 5-fold difference in interval resection rates.
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References29
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#1H. E. BolkensteinH-Index: 4
Last. Werner A. DraaismaH-Index: 24
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Objective:The aim of this study was to establish whether surgical or conservative treatment leads to a higher quality of life (QoL) in patients with recurring diverticulitis and/or ongoing complaints.Summary of Background Data:The 6 months’ results of the DIRECT trial, a randomized trial comparing e
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#1Sebastiano Biondo Aglio (Bellvitge University Hospital)H-Index: 36
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#1Ueli Zellweger (UZH: University of Zurich)H-Index: 8
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Last. Matthias Bopp (UZH: University of Zurich)H-Index: 37
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Cause of death statistics are an important tool for quality control of the health care system. Their reliability, however, is controversial. Comparing death certificates with their corresponding medical records is implemented only occasionally but may point to quality problems. We aimed at exploring the agreement between information in the cause of death statistics and hospital discharge diagnoses at death. Selection of disease categories was based on ICD-10 Tabulation List for Morbidity and ICD...
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Last. Christoph KettelhackH-Index: 13
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AIM: The standard of care for acute uncomplicated diverticulitis used to be an elective colon resection after the second or third episode. This practice was replaced by a more conservative and individualized approach. This study investigates current surgical practice in the treatment of acute uncomplicated diverticulitis in Switzerland. METHOD: Retrospective cross-sectional analysis of all hospital admissions due to uncomplicated diverticulitis in Switzerland using prospectively collected data f...
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Last. David R. Flum (UW: University of Washington)H-Index: 62
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Objective:To determine the impact of elective colectomy on emergency diverticulitis surgery at the population level.Background:Current recommendations suggest avoiding elective colon resection for uncomplicated diverticulitis because of uncertain effectiveness at reducing recurrence and emergency su
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#1John Rose (UCSD: University of California, San Diego)H-Index: 10
#2Ralitza Parina (UCSD: University of California, San Diego)H-Index: 12
Last. Mark A. Talamini (SBU: Stony Brook University)H-Index: 54
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OBJECTIVE: This study aims to determine the long-term outcomes of diverticulitis and to apply the findings to current practice patterns. BACKGROUND: The long-term morbidity and mortality of diverticulitis are not well defined. Current practice guidelines for diverticulitis are based on limited evidence. METHODS: The California Office of Statewide Health Planning and Development database was queried for longitudinal observations across all hospitals from 1995 to 2009. Recurrence up to 15 years, m...
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#1Adil E. BharuchaH-Index: 54
#2Gopanandan Parthasarathy (Mayo Clinic)H-Index: 8
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Temporal Trends in the Incidence and Natural History of Diverticulitis: A Population-Based Study
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#1Hugh Paterson (Western General Hospital)H-Index: 15
#2I. D. R. Arnott (Western General Hospital)H-Index: 19
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Aim Symptomatic diverticular disease (DD) may be increasing in incidence in western society particularly in younger age groups. This study aimed to describe hospital admission rates and management for DD in Scotland between 2000 and 2010. Method Data were obtained from the Scottish Morbidity Records (SMR01). The study cohort included all patients with a hospital admission and a primary diagnosis of DD of the large intestine (ICD-10 primary code K57). Results Scottish NHS hospitals reported 90 99...
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#1S. Vennix (EUR: Erasmus University Rotterdam)H-Index: 4
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Last. W. A. BemelmanH-Index: 37
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The study aimed to analyse the currently available national and international guidelines for areas of consensus and contrasting recommendations in the treatment of diverticulitis and thereby to design questions for future research. MEDLINE, EMBASE and PubMed were systematically searched for guidelines on diverticular disease and diverticulitis. Inclusion was confined to papers in English and those < 10 years old. The included topics were classified as consensus or controversy between guidelines,...
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