Vlad V. Simianu, M.D., M.P.H., of the University of Washington, Seattle, and colleagues examined patterns of episodes of diverticulitis before surgery and factors associated with earlier interventions using inpatient, outpatient, and antibiotic prescription claims. The study was published online by JAMA Surgery.
Despite professional recommendations to delay elective colon resection for patients with uncomplicated diverticulitis, early surgery (after less than 3 preceding episodes) appears to be common. This study included 87,461 immunocompetent patients having at least 1 claim for diverticulitis, of whom 6.4 percent (n = 5,604) underwent a resection, from January 2009 to December 2012. The final study cohort comprised 3,054 non-immunocompromised patients who underwent elective resection for uncomplicated diverticulitis.
After considering all types of diverticulitis claims, the researchers found that 56 percent (1,720 of 3,054) of elective resections for uncomplicated diverticulitis occurred after fewer than 3 episodes. Earlier surgery was not explained by younger age, laparoscopy, time between the last 2 episodes preceding surgery, or financial risk-bearing for patients. "In our nation's quest to deliver higher-value health care, understanding what constitutes appropriate care for a growing population of patients with diverticulitis and encouraging adherence to appropriateness criteria are critical. These data suggest that there is a strong need for fundamental research in this setting."
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