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International Journal of Colorectal Disease

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Open Access 01-05-2018 | Review

A systematic review and meta-analysis of outpatient treatment for acute diverticulitis

Authors: S. T. van Dijk, K. Bos, M. G. J. de Boer, W. A. Draaisma, W. A. van Enst, R. J. F. Felt, B. R. Klarenbeek, J. A. Otte, J. B. C. M. Puylaert, A. A. W. van Geloven, M. A. Boermeester

Published in: International Journal of Colorectal Disease | Issue 5/2018

Abstract

Background

The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient treatment, potentially reducing the burden of one of the most common gastrointestinal diseases in the Western world.

Purpose

Assessing the safety and cost savings of outpatient treatment in acute colonic diverticulitis.

Methods

PubMed and EMBASE were searched for studies on outpatient treatment of colonic diverticulitis, confirmed with computed tomography or ultrasound. Outcomes were readmission rate, need for emergency surgery or percutaneous abscess drainage, and healthcare costs.

Results

A total of 19 studies with 2303 outpatient treated patients were included. These studies predominantly excluded patients with comorbidity or immunosuppression, inability to tolerate oral intake, or lack of an adequate social network. The pooled incidence rate of readmission for outpatient treatment was 7% (95%CI 6–9%, I² 48%). Only 0.2% (2/1288) of patients underwent emergency surgery, and 0.2% (2/1082) of patients underwent percutaneous abscess drainage. Only two studies compared readmission rates outpatients that had similar characteristics as a control group of inpatients; 4.5% (3/66) and 6.3% (2/32) readmissions in outpatient groups versus 6.1% (4/66) and 0.0% (0/44) readmissions in inpatient groups (p = 0.619 and p = 0.174, respectively). Average healthcare cost savings for outpatient compared with inpatient treatment ranged between 42 and 82%.

Conclusion

Outpatient treatment of uncomplicated diverticulitis resulted in low readmission rates and very low rates of complications. Furthermore, healthcare cost savings were substantial. Therefore, outpatient treatment of uncomplicated diverticulitis seems to be a safe option for most patients.

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Title: A systematic review and meta-analysis of outpatient treatment for acute diverticulitis
Authors: S. T. van Dijk
K. Bos
M. G. J. de Boer
W. A. Draaisma
W. A. van Enst
R. J. F. Felt
B. R. Klarenbeek
J. A. Otte
J. B. C. M. Puylaert
A. A. W. van Geloven
M. A. Boermeester
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 5/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-3015-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A systematic review and meta-analysis of outpatient treatment for acute diverticulitis

Abstract

Background

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Purpose

Methods

Results

Conclusion

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