Emergency Department Burden of Diverticulitis in the USA, 2006–2013

Abstract

Goals The aim of this study was to analyze recent trends in ED visits for diverticulitis between 2006 and 2013. Background Acute diverticulitis is a serious medical condition that frequently leads to emergency department (ED) visits, hospitalizations, and surgeries resulting in a significant health care burden. Methods Data were obtained from the National Emergency Department Sample (NEDS) records in which diverticulitis (ICD-9-CM codes 562.11 and 562.13) was the primary diagnosis in the ED between 2006 and 2013. The NEDS collects data from more than 25 million visits in over 950 hospital emergency departments and is weighted to provide national estimates. Our findings reflected patient and hospital characteristics such as demographics, geographical region, and total charges for ED and inpatient stays. Results Between 2006 and 2013, the rate of diverticulitis-related ED visits increased by 26.8% from 89.8 to 113.9 visits per 100,000 population. The aggregate national cost of diverticulitis-related ED visits increased by 105%, from approximately $822 million in 2006 to over $1.6 billion in 2013. Cost data were adjusted for inflation and reported in 2015 dollars. The percentage of individuals admitted to the same hospital from the ED decreased from 58.0% to 47.1% from 2006 to 2013 respectively while the rate of bowel surgeries per 100,000 ED visits for diverticulitis decreased 33.7% from 2006 to 2013. Conclusions The number of ED visits due to diverticulitis and associated costs continued to rise between 2006 and 2013, while the rate of bowel surgeries and inpatient admissions through the ED for diverticulitis decreased.

The Burden of Diverticular Disease and Its Complications: West versus East

“…Delvaux [61] reported that there were almost 800,000 hospital admissions for diverticular disease in European countries. As a countermeasure for the burden of diverticular disease, a systematic review reported that there was no difference in failure rates of medical treatment (6.5 vs. 4.6%) and recurrence rates (13.0 vs. 12.1%) between patients who received ambulatory care and those who received inpatient care for uncomplicated diverticulitis [62]. Ambulatory treatment was associated with daily cost savings of between 600 and 1,900 EUR per patient treated.…”

“…In patients for whom surgery is indicated, a recent meta-analysis showed that, compared to open surgery, laparoscopic surgery for diverticular disease was associated with a significantly reduced length of stay and fewer complications [66]. Recently, Bollom et al [62] reported that the number of emergency department visits due to diverticulitis and associated costs continued to rise between 2006 and 2013, whereas the rate of bowel surgeries and inpatient admissions through the emergency department for diverticulitis has decreased [67]. Diverticular bleeding can be massive and recurs frequently; therefore, it involves repeated examination, hospitalization, and blood transfusion.…”

Acute uncomplicated diverticulitis managed without antibiotics – difficult to introduce a new treatment protocol but few complications

“…During the twentieth century, the incidence of acute diverticulitis has been rising and so have the treatment costs [1][2][3]. Acute diverticulitis is classified as uncomplicated or complicated.…”

American Association for the Surgery of Trauma emergency general surgery guideline summaries 2018: acute appendicitis, acute cholecystitis, acute diverticulitis, acute pancreatitis, and small bowel obstructionAcute cholecystitis management guidelines summaryAcute colonic diverticulitis management guidelines summaryIntestinal obstruction due to adhesions guideline summaryAcute pancreatitis management guidelines summary

“…1 Between 2000 and 2009, admissions for diverticulitis increased 41%, representing over 219 000 discharges and US$2.1 billion dollars in inpatient charges. 2 As the population ages, these numbers are likely to increase, since at least 60% of people over the age of 60 have diverticulosis and 10%–25% will progress to diverticulitis at some point. 2-3 Though 85% of these episodes are likely to be uncomplicated, 15%–30% will experience at least one recurrence.…”

“…2 As the population ages, these numbers are likely to increase, since at least 60% of people over the age of 60 have diverticulosis and 10%–25% will progress to diverticulitis at some point. 2-3 Though 85% of these episodes are likely to be uncomplicated, 15%–30% will experience at least one recurrence. 3…”