WP5.4 - Uncomplicated acute diverticulitis can be managed in an ambulatory setting

Abstract

Abstract Aims We aimed to evaluate a treatment pathway for acute diverticulitis at our Surgical Emergency Unit (SEU) and analyse the outcomes. We hypothesised that a significant number of patients can be managed in an ambulatory setting. Methods We reviewed clinical records of all adult patients (aged ≥18 years) admitted with acute diverticulitis between April 2022 to March 2023. Those presenting with clinical suspicion of acute diverticulitis were assessed clinically, biochemically and radiologically with cross-sectional imaging. This allowed early detection and treatment for those with complications of diverticulitis, and early ambulation within 24 hours for those without. We evaluated their length of stay, modified Hinchey classification of disease severity, antibiotic prescription, and readmission for diverticulitis within 3 months after discharge. Results We included 370 patients (160 males, 210 females). The mean age was 63.2 (range 23-96) years. Fifty-five (14.9%) presented with acute complicated diverticulitis (Hinchey classification 1b or above). In total, 218 patients (58.9%) were ambulated within 24 hours of presentation. The proportion of patients ambulated early with and without complications of diverticulitis were 21.8% (12/55) and 65.4% (206/315) respectively (p<0.001). The average length of stay in hospital was 54 (range 0.3-711) hours. Among those ambulated early, 196 were prescribed with oral antibiotics. Only 10 patients (4.6%) had persistent symptoms after 2 weeks from ambulation. Twenty-six patients (11.9%) were subsequently readmitted within 3 months. Conclusions In our experience, over half of patients diagnosed with acute diverticulitis were successfully managed on an ambulatory pathway. There was a low percentage with persistent symptoms or readmission. The development of appropriate patient pathways is crucial to improve efficient use of hospital resources.