Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis?

PURPOSE: Indications for operative intervention in the treatment of diverticulitis have become unclear. We hypothesized that surgical treatment for diverticulitis has decreased resulting in proportionately more complicated diverticulitis cases (free perforation and/or abscess).

METHODS: We conducted a retrospective analysis of patients with diverticular disease in the Nationwide Inpatient Sample from 1991 through 2005. We used diagnostic codes to identify all patient discharges with diverticular disease and then determined the proportion of discharges with diverticulitis, perforated disease, diverticular abscess, and surgical treatment.

RESULTS: During the study period, 685,390 diverticulitis discharges were recorded. The ratio of diverticulitis discharges increased from 5.1 cases per 1,000 inpatients in 1991 to 7.6 cases per 1,000 inpatients in 2005 (P < 0.0001). The proportion of patients who underwent colectomy for uncomplicated diverticulitis declined from 17.9% in 1991 to 13.7% in 2005 (P < 0.0.0001). During the same period, the proportion of free diverticular perforations as a fraction of all diverticulitis cases remained unchanged (1.5%). The proportion of diverticular abscess discharges as a fraction of all diverticulitis cases increased from 5.9% in 1991 to 9.6% in 2005 (P < 0.0001). Last, we noted a decrease in diverticular perforations and/or abscess treated with colectomy, 71.0% in 1991 to 55.5% in 2005 (P < 0.0001).

CONCLUSIONS: Despite a significant decline in surgical treatment for diverticulitis, there has been no change in the proportion of patients discharged for free diverticular perforation. There was an increase in diverticular abscess discharges, but this finding was not associated with an increase in same stay surgical treatment.