Major increase in admission- and incidence rates of acute colonic diverticulitis

Abstract

PurposeHospitalization for acute colonic diverticulitis has become more and more frequent. We studied the changes in the rate of admission and incidence of the disease during the last 25 years.MethodsWe performed a retrospective analysis of all cases treated for acute diverticulitis during 1988–2012 at one hospital serving a defined population in Mid-Norway. The study made a distinction between admission rates and incidence rates. The admission rates defined the total number of cases admitted, while the incidence rates defined the number of new patients hospitalized for acute diverticulitis (first admission). Poisson regression was used to analyse factors associated with diverticulitis incidence rates.ResultsA total of 851 admissions in 650 different patients were identified, with an overall admission rate of 38.5 (CI 35.9 to 41.1) per 100,000 person-years. The admission rate increased from 17.9 (CI 14.1 to 22.3)/100,000 during 1988–1992 to 51.1 (CI 44.8 to 58.0)/100,000 during 2008–2012. Poisson regression analysis showed a significant increase in admission rates with a factor of 2.8 (C.I. 2.2 to 3.5) during 25 years. The overall incidence rate (IRR) of new patients was 29.4 (CI 27.1 to 31.7)/100,000 person-years. IRR increased significantly with a factor of 2.6 (CI 1.96 to 3.34) during 25 years, while IRR for perforations increased even more, by a factor of 3.3 (CI 1.24 to 8.58).ConclusionThe hospital admission rates as well as incidence rates for acute colonic diverticulitis increased significantly during the 25-year time span.

Temporal Trends in the Incidence and Natural History of Diverticulitis: A Population-Based Study

“…Between 1998 and 2005, hospital admissions and elective operations for diverticulitis increased by 26% and 29%, respectively, and by more than 70% each in patients younger than 45 years (6). These trends, also reported elsewhere (7–10), are of concern. Indeed, it has been estimated that approximately 16% of patients hospitalized for acute diverticulitis will undergo surgery for the same (11).…”

Risk factors of admission for acute colonic diverticulitis in a population-based cohort study: The North Trondelag Health Study, Norway

“…We are not aware of any change in admission policy for acute colonic diverticulitis during the study period. In addition to using the ICD-codes set by the doctor in charge at discharge, every hospital record was reviewed to ensure a higher probability of a correct diagnosis and prevent misclassifications[4]. Still, the diagnosis of acute colonic diverticulitis may have been incorrect in a minority of patients with known diverticulosis, who presented with pain in the lower abdomen, fever and an elevated CRP, without a CT scan.…”

“…Acute diverticulitis is the most common complication of colonic diverticulosis[3], with increasing incidence and admission rates in recent years[4,5]. Acute diverticulitis may also recur in 9% to 23% of patients[6].…”

Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis

“…The recurrence rate is high, ranging from 6 to 25 % in the subsequent years after the first episode [2, 5], causing repeated consultation and treatment in the primary healthcare and potential hospital readmission. Patients with uncomplicated acute diverticulitis do not necessarily require hospital admission and may be treated on an out-patient basis.…”

“…The rate of complicated acute colonic diverticulitis is highest during the primary admission, and the majority of readmitted patients have uncomplicated disease [2, 15]. A repeated CT scan may be omitted in patients with clinical recurrent disease and a previously documented history of diverticulitis, especially with C-reactive protein (CRP) <50 mg/mL [16].…”