Out-Patient Management of Mild or Uncomplicated Diverticulitis: A Systematic Review

Balasubramanian, Ishwarya; Fleming, Christina; Mohan, Helen; Schmidt, Karl P.; Haglind, Eva; Winter, D. C.

doi:10.1159/000450865

Cited by 30 publications

(24 citation statements)

References 24 publications

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“…Ambulatory treatment was associated with daily cost savings of between 600 and 1,900 EUR per patient treated. One study showed that provision of care by an integrated multidisciplinary digestive health service can significantly reduce overall costs (p = 0.0497) and the length of hospital stay (p = 0.017) in patients admitted for diverticulitis compared to costs for care provided by nonintegrated inpatients services [63]. Moreover, a recent systematic review showed that care by gastroenterologists was associated with a significantly shorter length of stay than care provided by general physicians [64].…”

Section: Burden Of Diverticular Diseasementioning

confidence: 99%

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

Imaeda¹,

Hibi²

2018

Inflamm Intest Dis

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Background: Colonic diverticulosis is prevalent and increasing not only in Western but also in Asian countries. Diverticulosis can be complicated by diverticulitis and diverticular bleeding. Diverticular disease is a burdensome digestive disease, because it is a major cause of hospital admissions and is associated with significant health-care costs. Summary: The incidence of diverticulosis increases with age. Most cases of diverticulosis in Western countries involve the left side of the colon, while diverticulosis is predominantly present on the right side of the colon in Asian countries. The incidence of diverticulitis also increases with age. Diverticulitis is predominantly located on the left side of the colon in Western countries, while it is predominantly located on the right side of the colon in Asian countries. The overall complication rate is higher in left-sided than in right-sided diverticulitis. The incidence of diverticular bleeding also increases with age. The right colon is the source of diverticular bleeding in more than 50% of patients in Western countries. In Asian countries, age greater than 70 years and both-sided diverticulosis increase the bleeding risk. Key Messages: In Western countries, diverticulosis and diverticulitis are predominantly located on the left side of the colon, whereas they are predominantly present on the right side of the colon in Asian countries. Diverticular bleeding is predominantly located on the right side in Western countries, and both-sided diverticulosis increases the risk of bleeding in Asian countries. Diverticular disease with complications requires admission and operation; moreover, it recurs frequently. Therefore, diverticular disease is associated with a significant economic burden in terms of health-care costs and resource utilization.

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Section: Burden Of Diverticular Diseasementioning

confidence: 99%

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

Imaeda¹,

Hibi²

2018

Inflamm Intest Dis

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“…In a review of 10 studies comparing inpatient and outpatient management, similar failure rates (6.5% versus 4.6%) and recurrence rates (13.0% versus 12.1%) were found, and in a meta‐analysis of 2303 patients, there was only a 7% readmission rate, 0.4% need for emergency intervention and a 40–80% reduction in overall cost with outpatient treatment . Whilst the data are largely comprised of retrospective reviews and randomized trials with notable limitations, the safety of outpatient management of uncomplicated diverticulitis in well‐selected patient groups remains quite convincing.…”

mentioning

confidence: 79%

Continuous evolution of the management of sigmoid diverticulitis

Ravindran

Phan‐Thien

Lubowski

2019

ANZ Journal of Surgery

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“…In addition, in terms of follow‐up, the rate of patients seen subsequently in our outpatient service decreased from 53% to 22%. This, along with the significant decrease in hospital admissions should translate to significant reductions in healthcare costs with a decreased burden on hospital resources …”

Section: Discussionmentioning

confidence: 99%

Reduction in hospital admissions with an early computed tomography scan: results of an outpatient management protocol for uncomplicated acute diverticulitis

Juszczyk

Ireland

Kroon

et al. 2019

ANZ Journal of Surgery

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Background: There is increasing evidence that uncomplicated acute diverticulitis (UAD) can be safely and effectively managed as an outpatient. The aim of the current study was to evaluate if an early computed tomography (CT) scan in the emergency department (ED) can reduce the number of hospital admissions when UAD is diagnosed, without compromising patient safety. Methods: A protocol was introduced in 2015, whereby patients with suspected diverticulitis receive a CT scan on presentation to the ED and be considered for discharge home on oral antibiotics if UAD is confirmed. A retrospective analysis of a prospectively collected database was conducted for all patients presenting to the ED with acute diverticulitis over a 4-year period: 2 years prior (May 2013-April 2015; pre-protocol) and 2 years after implementation of the protocol (May 2015-April 2017; post-protocol). Results: A total of 1147 patients presented to the ED, who were diagnosed with diverticulitis, and UAD was confirmed in 552 patients. There was a significant decrease in hospital admissions for UAD in the post-protocol group from 93% to 39% (P < 0.0001) and in the total number of hospital admission days from 602 to 370 (P < 0.0001). There was no increase in representations between both periods (7% versus 6%; P = 0.49). Conclusion: Definitive diagnosis by early CT scan in the ED decreased the admission rate for UAD by more than 50%, and significantly reduced the total number of hospital days without resulting in an increase in representations. UAD can safely and effectively be treated in an outpatient setting leading to a reduction in the burden on the health system.

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Out-Patient Management of Mild or Uncomplicated Diverticulitis: A Systematic Review

Cited by 30 publications

References 24 publications

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

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

Continuous evolution of the management of sigmoid diverticulitis

Reduction in hospital admissions with an early computed tomography scan: results of an outpatient management protocol for uncomplicated acute diverticulitis

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