Diverticulitis a continued source of morbidity in the USA
MedWire News: A review of US trends shows that diverticulitis continues to be a source of significant morbidity, with hospital admissions increasing between 2002 and 2007.
Overall, there was a 4.3% increase in surgical resections and a dramatic 38.7% increase in elective surgical resections, report Michael Stamos (University of California, Irvine, USA) and colleagues in Archives of Surgery.
David Rothenberger (University of Minnesota, Minneapolis, USA), who wrote an editorial accompanying the study, said the increase in resections "occurred despite a growing consensus that indication(s) for surgery should be more restricted than in the past."
The current review of data from the US National Inpatient Sample included more than 1 million patients admitted with diverticulitis over the 5-year period. During this time, the rate of emergent admissions increased nearly 10%.
For emergent patients, who represented 78% of the cohort, approximately one in 10 were treated with urgent surgical resection, while 88% were treated with nonoperative methods.
The overall rate of laparoscopic colon resection was 10.5%, increasing from 6.9% in 2002 to 13.5% in 2007. But for urgent cases of diverticulitis, just 3.9% of patients underwent laparoscopic colectomy, report Stamos and colleagues.
The researchers also noted that the likelihood of requiring a colostomy during elective surgery declined from 2002 to 2007. This translated into a significant increase in primary anastomosis rates for elective resections, up from 92.0% in 2002 to 94.5% in 2007.
Overall, in-hospital mortality rates declined in elective and urgent surgery. For elective surgery, in-hospital mortality rates declined from 0.53% in 2002 to 0.44% in 2007, while the rate declined from 4.5% in 2002 to 2.5% in 2007 for those who underwent emergent surgery.
In his editorial, Rothenberger said the current study "raises more questions than it answers."
For example, he said that when it comes to diverticulitis, American surgeons "seem to be operating electively on more patients than ever and yet we are slow to adopt techniques that may lower morbidity and possibly cost less."
He added that surgeons need to have a full arsenal of techniques at their disposal, including laparoscopic techniques, if they are to make decisions in the best interest of their patients.
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By MedWire Reporters