Eficiencia y seguridad del tratamiento ambulatorio de la diverticulitis aguda

Gil, Jorge Martín; Colsa, Daniel Serralta de; Marín, Andrés García; Rodríguez, A. Vaquero; Valcárcel, Cristina Rey; Díaz, María Dolores Pérez; Sánchez, Mercedes Sanz; Fuentes, Fernando

doi:10.1016/j.gastrohep.2008.10.005

Cited by 21 publications

(6 citation statements)

References 11 publications

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“…The first was a prospective Japanese study , in which 68 of 70 patients with uncomplicated AD were treated successfully with oral antibiotics at home. Other authors have found similar results, including one 693‐patient study which randomized two groups to intravenous in‐hospital treatment vs oral treatment at home , albeit with a retrospective observational design. Our study had similar success with outpatient management of uncomplicated AD, with 94% of patients selected for the outpatient programme successfully managed without readmission.…”

Section: Discussionmentioning

confidence: 62%

Application of a modified Neff classification to patients with uncomplicated diverticulitis

et al. 2013

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Section: Discussionmentioning

confidence: 62%

Application of a modified Neff classification to patients with uncomplicated diverticulitis

et al. 2013

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“…Most studies selected patients as outpatient treatment candidates based on patient characteristics (such as absence of comorbidities or immunosuppressed state), clinical condition (such as having uncomplicated diverticulitis and ability to tolerate oral intake) and patients’ social environment (adequate family and social network). Importantly, seven studies [ 22 , 28 , 29 , 31 , 33 – 35 ] also included patients with diverticular abscesses as candidates for outpatient treatment. Although most studies used outpatient treatment protocols that could be used in almost all hospitals (ambulatory treatment at home with an outpatient clinic visit after 4 to 7 days), 3 studies treated their patients in a ‘hospital at home unit’ or ‘home care unit’ [ 26 , 27 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…Only in a randomized clinical trial [ 17 ] (randomizing between in- or outpatient treatment of uncomplicated diverticulitis patients) and a prospective cohort study [ 24 ] (selecting patients based on the time period they were treated in; before or after a change in hospital guidelines), a reliable comparison of outcomes could be made. All 19 studies reported rates of readmission, 16 studies [ 17 – 22 , 24 – 27 , 30 – 32 , 34 – 36 ] reported rates of need for emergency surgery, 15 studies [ 17 – 20 , 22 , 24 – 27 , 30 – 32 , 34 – 36 ] reported need for percutaneous abscess drainage, and 5 studies [ 17 , 22 , 24 , 26 , 30 ] reported healthcare costs. All study characteristics are shown in Online Resource 4 .…”

Section: Resultsmentioning

confidence: 99%

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

Dijk

Bos

Boer

et al. 2018

Int J Colorectal Dis

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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.

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“…Sixty-eight of 70 patients were successfully treated [8]. A prospective study in outpatients with an established diagnosis of diverticulitis with grades Hinchey I and II treated with ciprofloxacin and metronidazol demonstrated a need for hospital admission in only 5.6% of the patients [9]. In conclusion, selected patients with diverticulitis can be successfully managed on an outpatient basis.…”

Section: Conservative Treatmentmentioning

confidence: 99%

Appendicitis/Diverticulitis: Diagnostics and Conservative Treatment

Kruis

Morgenstern

Schanz³

2013

Dig Dis

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Appendicitis and diverticulitis are very common entities that show some similarities in diagnosis and course of disease. Both are widely believed to be simple clinical diagnoses, which is in contrast to scientific evidence. An accurate diagnosis has to describe not only the initial detection, but particularly the severity of the disease. It is based mainly on cross-sectional imaging by ultrasound (US) and computed tomography (CT). Appendectomy is the standard treatment for acute appendicitis and is mandatory in complicated cases. Antibiotic therapy is similarly effective in uncomplicated appendicitis, but long-term results are not sufficiently known. Treatment of diverticulitis is related to the disease status. Complications such as perforation and bleeding require intervention. Uncomplicated diverticulitis as graded by US or CT are subject to conservative management, in the form of outpatient or hospital care. It is an unresolved debate as to whether antibiotic treatment offers benefits. Mesalazine seems at least to improve pain. The real challenge is treatment of recurrent diverticulitis. Lifestyle measures such as nutritional habits and physical activity are found to influence diverticular disease. Besides immunosuppression, obesity is a significant risk factor for complicated diverticulitis. Whether any medication such as chronic antibiotics, probiotics or mesalazine offers benefits is unclear. The indication for sigmoid resection has changed; it is no longer given by the number of attacks, but rather by structural changes as depicted by cross-sectional imaging.

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Eficiencia y seguridad del tratamiento ambulatorio de la diverticulitis aguda

Cited by 21 publications

References 11 publications

Application of a modified Neff classification to patients with uncomplicated diverticulitis

Application of a modified Neff classification to patients with uncomplicated diverticulitis

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

Appendicitis/Diverticulitis: Diagnostics and Conservative Treatment

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