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

Marcus von Strauss und Torney, Giusi Moffa, Max Kaech, Fabian Haak, Stefan Riss, Elisabeth Deutschmann, Heiner C Bucher, Christoph Kettelhack, Hugh Paterson

Research output: Contribution to journalArticlepeer-review

Abstract

Abstract
Importance:
National guidelines on interval resection for prevention of recurrence after complicated diverticulitis are inconsistent. While US and German guidelines favor interval colonic resection to prevent a perceived high risk of recurrence, UK guidelines do not.
Objective
We investigated patient management and outcomes following an index inpatient episode of non-operatively managed complicated diverticulitis in Switzerland and Scotland to determine if interval resection influenced the rate of disease-specific emergency surgery or death in either country.
Design
This was a secondary analysis of anonymized complete national inpatient datasets..
Setting
This was a population-based study in two countries with contrasting healthcare systems: insurance-funded (Switzerland) vs. state-funded (Scotland)
Participants
All patients with an inpatient episode of successfully non-operatively managed complicated diverticulitis in Switzerland and Scotland from 1st Jan 2005 to 31st Dec 2015.
Main Outcome
The primary endpoint defined a priori before the analysis was adverse outcome, defined as any disease-specific emergency surgical intervention or inpatient death following an initial successful non-surgical inpatient management of an episode of complicated diverticulitis, including complications from interval elective surgery.
Results
The study cohort comprised 13,861 (Switzerland) and 5129 (Scotland) inpatients with an index episode of complicated acute diverticulitis managed non-operatively. The primary endpoint was observed in 698 (5.0%) Swiss and 255 (5.0%) Scottish patients (odds ratio 0.98, 95% CI 0.81, 1.19). Elective interval colonic resection was undertaken in 3280 (23.7%) Swiss and 231 (4.5%) Scottish patients (median follow-up 54 months). Death following 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 influence on the outcome apart from comorbidity.
Conclusion and Relevance
We found no difference in the rate of adverse outcome (emergency surgery/inpatient death) despite a five-fold difference in interval resection rates
Original languageEnglish
JournalJAMA surgery
Early online date13 May 2020
DOIs
Publication statusE-pub ahead of print - 13 May 2020

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