ANZ journal of surgery · 2025
Significant Reduction in Length of Stay Through the Introduction of an Outpatient Management Protocol for Uncomplicated Left-Sided Diverticulitis.
СтатьяНазвание и аннотация: Перевод в очереди
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Balhorn Joshua M, Udayasiri Dilshan K, Hayes Ian P, McCormick Jacob J, Read David J, Chandra Raaj, Chittleborough Timothy J
Аннотация
PURPOSE: Acute diverticulitis is a common presentation to hospital emergency departments (ED) and a significant burden on healthcare resources worldwide. Multiple studies have shown that outpatient management of uncomplicated diverticulitis is safe, yet many patients are still treated in the hospital. We instituted a protocol for the outpatient treatment at our institution, focusing on safety and healthcare costs.
METHODOLOGY: From February 2021, the new outpatient management of uncomplicated left-sided diverticulitis protocol was implemented; all patients that presented through the ED with a computed tomography diagnosis of uncomplicated left-sided diverticulitis were managed as an outpatient with oral antibiotics unless they met exclusion criteria (insulin-dependent diabetes, immunosuppression, active malignancy, pregnancy, or inflammatory bowel disease). This was compared to a historical comparison immediately prior. The primary outcome of interest was length of stay (LOS) in hours.
RESULTS: There were 106 patients in each group. The LOS in the outpatient group was 29.7 h less than in the inpatient group (95% CI 21.9-37.5; p < 0.001). Patients with co-morbidities stayed significantly longer, with ASA 3 and 4 more than 17 h (53 h vs. 35 h, p < 0.001), and a high CCI (score ≥ 5) more than 32 h (67 h vs. 35 h, p < 0.001). The odds of readmission were not significantly different between the outpatient and inpatient cohorts (OR 1.49, 95% CI 0.54-4.07, p = 0.438).
CONCLUSION: Outpatient management for uncomplicated left-sided diverticulitis results in a significant reduction of LOS and does not result in an increase in readmissions.
METHODOLOGY: From February 2021, the new outpatient management of uncomplicated left-sided diverticulitis protocol was implemented; all patients that presented through the ED with a computed tomography diagnosis of uncomplicated left-sided diverticulitis were managed as an outpatient with oral antibiotics unless they met exclusion criteria (insulin-dependent diabetes, immunosuppression, active malignancy, pregnancy, or inflammatory bowel disease). This was compared to a historical comparison immediately prior. The primary outcome of interest was length of stay (LOS) in hours.
RESULTS: There were 106 patients in each group. The LOS in the outpatient group was 29.7 h less than in the inpatient group (95% CI 21.9-37.5; p < 0.001). Patients with co-morbidities stayed significantly longer, with ASA 3 and 4 more than 17 h (53 h vs. 35 h, p < 0.001), and a high CCI (score ≥ 5) more than 32 h (67 h vs. 35 h, p < 0.001). The odds of readmission were not significantly different between the outpatient and inpatient cohorts (OR 1.49, 95% CI 0.54-4.07, p = 0.438).
CONCLUSION: Outpatient management for uncomplicated left-sided diverticulitis results in a significant reduction of LOS and does not result in an increase in readmissions.