Outcomes after non-operative management of perforated diverticular disease: a population-based cohort study.

A Adiamah,J West,D J Humes,C J Crooks,L Ban,H Otete

doi:10.1093/bjsopen/zraa073

Abstract

BackgroundThe management of perforated diverticular disease has changed in the past 10 years with a move towards less surgical intervention. This population-based cohort study aimed to define the risk of death and readmission following non-operative management of perforated diverticular disease.MethodsPatients diagnosed with perforated diverticular disease and managed without surgery were identified from the linked Clinical Practice Research Datalink and Hospital Episode Statistics data from 2000 to 2013. The outcomes were 1-year case fatality, readmissions, and surgery at readmission.ResultsIn total, 880 patients with perforated diverticular disease were managed without surgery, comprising 523 women (59.4 per cent). The 1-year case fatality rate was 33.2 per cent (293 of 880). The majority of deaths occurred in the first 90 days after the index admission, with a 90-day case fatality rate of 28.8 per cent. The 90-day survival rate varied by age, and was 97.2 per cent among those aged less than 65 years, compared with 85.0 per cent for those aged between 65 and 74 years, and 47.7 per cent in those at least 75 years old. Of 767 patients discharged from hospital, 250 (32.6 per cent) were readmitted (47 elective, 6.1 per cent; 203 emergency, 26.5 per cent) during a median of 1.6 (i.q.r. 0.1–3.9) years of follow-up, with similar proportions in each age category. In the first year of follow-up, only 5.1 per cent of patients required surgery, of whom 16 of 767 (2.1 per cent) required elective and 23 (3.0 per cent) emergency operation.ConclusionNon-operative management of perforated diverticulitis in those aged less than 65 years is feasible and safe. Reintervention rates following conservative management were low across all age categories.

Highlights

Perforation is the most severe complication of diverticular disease and is becoming more common[1,2,3]
Patients diagnosed with perforated diverticular disease and managed without surgery were identified from the linked Clinical Practice Research Datalink and Hospital Episode Statistics data from 2000 to 2013
An epidemiological study of Scottish National Health Service (NHS) hospitals reported an increase in annual emergency admissions for complicated diverticular disease from 22.9 per cent in 2000 to 27.1 per cent in 2010; this was associated with a decrease in the number of patients undergoing emergency surgery, suggesting that a greater proportion were being treated conservatively[5]

Summary

Introduction

Perforation is the most severe complication of diverticular disease and is becoming more common[1,2,3]. An epidemiological study of Scottish National Health Service (NHS) hospitals reported an increase in annual emergency admissions for complicated diverticular disease from 22.9 per cent in 2000 to 27.1 per cent in 2010; this was associated with a decrease in the number of patients undergoing emergency surgery, suggesting that a greater proportion were being treated conservatively[5] This change towards non-operative management is acknowledged in recent UK professional guidelines[6]. The natural history of patients with perforated diverticulitis who are managed conservatively in terms of disease recurrence, readmission rates, need for surgery, and mortality are poorly reported

Methods

Study design

Results

Discussion