Complicated Diverticulitis With Abscess Managed Nonoperatively at Index Admission: A Longitudinal Analysis of State Inpatient and Emergency Department Databases From the Healthcare Cost and Utilization Project.

INTRODUCTION

In 2020, clinical practice guidelines for the management of complicated diverticulitis shifted from recommending interval elective colectomy to consideration of elective resection. However, population level evidence for long-term outcomes following nonoperative management of complicated diverticulitis with abscess is limited.

METHODS

We performed a retrospective longitudinal analysis of hospital admissions for acute diverticulitis complicated by abscess from 2005 to 2015 from the State Inpatient and Emergency Department Databases from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Outcomes included time to colectomy and recurrent episodes. Multivariate logistic regression was used to compare patients managed nonoperatively to those who underwent surgery within 1 y of index admission.

RESULTS

Of 38,420 patients who survived an index admission for complicated diverticulitis with abscess without requiring surgical intervention, 24,214 (63.1%) were managed nonoperatively for at least 1 y following presentation. Of this group, 7.1% of the patients underwent surgery by year 3 and 10.4% by year 5. In the nonoperative group, there was a 10.2% recurrence rate, and 88.8% had no admissions. Patients with Medicaid (HR 0.73, CI 0.65-0.80), self-pay (HR 0.53, CI 0.47-0.59), and no charge (HR 0.56, CI 0.45-0.69) were less likely to undergo surgery than those with Medicare, while patients with private insurance were more likely. Non-White patients were less likely to undergo surgery than White patients.

CONCLUSIONS

Among patients with acute diverticulitis complicated by abscess successfully managed nonoperatively during their index admission, continued nonoperative management is an effective option given the population wide trends in recurrence, readmission, and procedural intervention in the subsequent years.