A systematic review and meta-analysis of outpatient treatment for acute diverticulitis

Abstract

BackgroundThe shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient treatment, potentially reducing the burden of one of the most common gastrointestinal diseases in the Western world.PurposeAssessing the safety and cost savings of outpatient treatment in acute colonic diverticulitis.MethodsPubMed and EMBASE were searched for studies on outpatient treatment of colonic diverticulitis, confirmed with computed tomography or ultrasound. Outcomes were readmission rate, need for emergency surgery or percutaneous abscess drainage, and healthcare costs.ResultsA total of 19 studies with 2303 outpatient treated patients were included. These studies predominantly excluded patients with comorbidity or immunosuppression, inability to tolerate oral intake, or lack of an adequate social network. The pooled incidence rate of readmission for outpatient treatment was 7% (95%CI 6–9%, I2 48%). Only 0.2% (2/1288) of patients underwent emergency surgery, and 0.2% (2/1082) of patients underwent percutaneous abscess drainage. Only two studies compared readmission rates outpatients that had similar characteristics as a control group of inpatients; 4.5% (3/66) and 6.3% (2/32) readmissions in outpatient groups versus 6.1% (4/66) and 0.0% (0/44) readmissions in inpatient groups (p = 0.619 and p = 0.174, respectively). Average healthcare cost savings for outpatient compared with inpatient treatment ranged between 42 and 82%.ConclusionOutpatient treatment of uncomplicated diverticulitis resulted in low readmission rates and very low rates of complications. Furthermore, healthcare cost savings were substantial. Therefore, outpatient treatment of uncomplicated diverticulitis seems to be a safe option for most patients.Electronic supplementary materialThe online version of this article (10.1007/s00384-018-3015-9) contains supplementary material, which is available to authorized users.

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

“…Two recent systematic reviews [93,94] have studied the evidence. One included 21 and the other 19 studies including one randomized trial [95] comparing inpatient and outpatient treatment for patients with uncomplicated diverticulitis, and comparable rates of readmission were found.…”

Medical hypothesis: speculating on the pathogenesis of acute diverticulitis

“…According to this theory, the role of bacterial overgrowth appears to be prominent, so that antibiotic therapy is actually considered the cornerstone therapy for acute diverticulitis. However, in the last decade, various studies have shown that acute uncomplicated diverticulitis may be safely managed without standard antibiotic therapy, at least in selected patients [ 10 ]. However, further long-term, randomized clinical trials will be required before we change our clinical practice.…”

Acute diverticulitis: an ongoing economic burden on the health system

“…Several studies have shown outpatient treatment to be safe for the treatment of mild disease in the absence of significant comorbidity, and where the patient is able to tolerate oral diet and antibiotics. 19,20 Isacson et al were able to demonstrate cost savings after their institution adopted a policy of selective outpatient management. Their total healthcare cost related to diverticulitis was Euro 558 679 in 2011 (preimplementation of outpatient policy) compared with Euro 370 370 in 2014 (P < 0.001).…”