Top

World Journal of Surgery

Published in:

01-08-2017 | Original Scientific Report

International Variation in Emergency Operation Rates for Acute Diverticulitis: Insights into Healthcare Value

Authors: Michael K. Y. Hong, Anita R. Skandarajah, Rose D. Higgins, Omar D. Faiz, Ian P. Hayes

Published in: World Journal of Surgery | Issue 8/2017

Abstract

Background

International comparison of outcomes of surgical diseases has become a global focus because of widespread concern over surgical quality, rising costs and the value of healthcare. Acute diverticulitis is a common disease potentially amenable to optimization of strategies for operative intervention. The aim was to compare the emergency operative intervention rates for acute diverticulitis in USA, England and Australia.

Methods

Unplanned admissions for acute diverticulitis were found from an international administrative dataset between 2008 and 2014 for hospitals in USA, England and Australia. The primary outcome measured was emergency operative intervention rate. Secondary outcomes included inpatient mortality and percutaneous drainage rate. Multivariable analysis was performed after development of a weighted comorbidity scoring system.

Results

There were 15,150 unplanned admissions for acute diverticulitis. The emergency operative intervention rates were 16, 13 and 10% for USA, England and Australia. The percutaneous drainage rate was highest in USA at 10%, while the mortality rate was highest in England at 2.8%. The propensity for emergency operative intervention was higher in USA (OR 1.45, p < 0.001) and England (OR 1.49, p < 0.001) than in Australia. The risk of 7-day mortality was higher in England than in Australia (OR 2.79, p < 0.001). Percutaneous drainage was associated with reduced 7-day mortality risk.

Conclusion

Australia has a lower propensity for emergency operative intervention, while England has a greater risk of mortality for acute diverticulitis. International variations raise the issue of healthcare value in terms of differing resource use and outcomes.

Available only for authorised users

Regenbogen SE, Hardiman KM, Hendren S et al (2014) Surgery for diverticulitis in the 21st century: a systematic review. JAMA Surg 149:292–303CrossRefPubMed

Yen L, Davis KL, Hodgkins P et al (2012) Direct costs of diverticulitis in a US managed care population. Am J Pharm Benefits 4:e118–e129

Ricciardi R, Baxter NN, Read TE et al (2009) Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis? Dis Colon Rectum 52:1558–1563CrossRefPubMed

Li D, Baxter NN, McLeod RS et al (2014) Evolving practice patterns in the management of acute colonic diverticulitis: a population-based analysis. Dis Colon Rectum 57:1397–1405CrossRefPubMed

Paterson HM, Arnott ID, Nicholls RJ et al (2015) Diverticular disease in Scotland: 2000–2010. Colorectal Dis 17:329–334CrossRefPubMed

Vather R, Broad JB, Jaung R et al (2015) Demographics and trends in the acute presentation of diverticular disease: a national study. ANZ J Surg 85(10):744–748CrossRefPubMed

Etzioni DA, Mack TM, Beart RW Jr et al (2009) Diverticulitis in the United States: 1998-2005—changing patterns of disease and treatment. Ann Surg 249:210–217CrossRefPubMed

Papagrigoriadis S, Debrah S, Koreli A et al (2004) Impact of diverticular disease on hospital costs and activity. Colorectal Dis 6:81–84CrossRefPubMed

Woolf SH, Aron LY (2013) The US health disadvantage relative to other high-income countries: findings from a National Research Council/Institute of Medicine report. JAMA 309:771–772CrossRefPubMed

10.

Porter ME (2010) What is value in health care? N Engl J Med 363:2477–2481CrossRefPubMed

11.

Bottle A, Middleton S, Kalkman CJ et al (2013) Global comparators project: international comparison of hospital outcomes using administrative data. Health Serv Res 48:2081–2210CrossRefPubMedPubMedCentral

12.

Hong MK, Tomlin AM, Hayes IP et al (2015) Operative intervention rates for acute diverticulitis: a multicentre state-wide study. ANZ J Surg 85:734–738CrossRefPubMed

13.

Hong MK, Skandarajah AR, Faiz OD et al (2016) How to use administrative data for surgical outcomes in acute diverticulitis. Gen Surg. doi:10.18282/gs.v1.i1.32

14.

Elixhauser A, Steiner C, Harris DR et al (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27CrossRefPubMed

15.

van Walraven C, Austin PC, Jennings A et al (2009) A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care 47:626–633CrossRefPubMed

16.

Rose J, Parina RP, Faiz O et al (2015) Long-term outcomes after initial presentation of diverticulitis. Ann Surg 262(6):1046–1053CrossRefPubMed

17.

Salem L, Anaya DA, Flum DR (2005) Temporal changes in the management of diverticulitis. J Surg Res 124:318–323CrossRefPubMed

18.

Mills AM, Holena DN, Kallan MJ et al (2013) Effect of insurance status on patients admitted for acute diverticulitis. Colorectal Dis 15:613–662CrossRefPubMed

19.

Saunders DI, Murray D, Pichel AC et al (2012) Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network. Br J Anaesth 109:368–375CrossRefPubMed

20.

Clarke A, Murdoch H, Thomas MJ et al (2011) Mortality and postoperative care after emergency laparotomy. Eur J Anaesthesiol 28:16–19CrossRefPubMed

21.

Dharmarajan S, Hunt S, Birnbaum E et al (2011) The efficacy of nonoperative management of acute complicated diverticulitis. Dis Colon Rectum 54:663–671CrossRefPubMed

22.

Elagili F, Stocchi L, Ozuner G et al (2014) Outcomes of percutaneous drainage without surgery for patients with diverticular abscess. Dis Colon Rectum 57:331–336CrossRefPubMed

23.

Singh B, May K, Coltart I et al (2008) The long-term results of percutaneous drainage of diverticular abscess. Ann R Coll Surg Engl 90:297–301CrossRefPubMedPubMedCentral

24.

Gaertner WB, Willis DJ, Madoff RD et al (2013) Percutaneous drainage of colonic diverticular abscess: is colon resection necessary? Dis Colon Rectum 56:622–626CrossRefPubMed

25.

Felder SI, Barmparas G, Lynn J et al (2013) Can the need for colectomy after computed tomography-guided percutaneous drainage for diverticular abscess be predicted? Am Surg 79:1013–1016PubMed

Title: International Variation in Emergency Operation Rates for Acute Diverticulitis: Insights into Healthcare Value
Authors: Michael K. Y. Hong
Anita R. Skandarajah
Rose D. Higgins
Omar D. Faiz
Ian P. Hayes
Publication date: 01-08-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 8/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-3965-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

International Variation in Emergency Operation Rates for Acute Diverticulitis: Insights into Healthcare Value

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2017

Patient Self-Assessment of Surgical Site Infection is Inaccurate

Breast Cancer Detection by Preoperative Imaging in Reduction Mammaplasty Patients: A Single Center Study of 918 Patients

Does Nissen Fundoplication Provide Lifelong Reflux Control? Symptomatic Outcome After 31–33 Years

A Novel Scoring System for Diagnosing Acute Mesenteric Ischemia in the Emergency Ward

Surgical Management of Iatrogenic Perforation of the Gastrointestinal Tract: 15 Years of Experience in a Single Center

Burden of Burns in Brazil from 2000 to 2014: A Nationwide Hospital-Based Study