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Diverticulitis: Why Operate Early?

It has become increasingly common for patients having experienced as few as three episodes of diverticulitis to opt for colectomy. A study examines the efficacy of younger, less frequent sufferers receiving the surgery earlier than guidelines typically recommend.

Surgery after fewer than three episodes of uncomplicated diverticulitis seems to be common even though most guidelines recommend delaying elective colon resection. This situation may be influenced by an increased likelihood of younger patients, availability of laparoscopic procedures, and appreciation for smoldering (non-recovering) diverticulitis.

Researchers from several institutions in the state of Washington looked for diverticulitis episode patterns in surgical candidates in an attempt to discover why early surgery is so common. Their study, published in JAMA Surgery, identifies several factors.

This investigation retrospective cohort study covered four calendar years, from 2009 through 2012. All study subjects were immunocompetent adults with incident, uncomplicated diverticulitis who underwent elective colectomy.

The researchers identified 87,461 patients with at least 1 claim for diverticulitis; 6.4%

(n = 5604) underwent resection and 3054 were eligible for the final cohort.

Before undergoing resection, the average patient had been admitted once, had 2 outpatient episodes, and had filled 0.5 prescriptions for antibiotics for diverticulitis.

Patients' average age was 47.7 years, and this was identical to patients who delayed. Based on inpatient claims only, the vast majority of patients (94.9%) had surgery after fewer than 3 episodes. That number fell to 80.5% if outpatient claims were included. After considering all types of diverticulitis claims including antibiotics, the researchers classified 56.3% of elective resections as "early."

Patients undergoing early surgery with less likely to undergo laparoscopy, and their pre-surgical episodes occurred less frequently (157 days apart) than patients who delayed (96 days apart).

Enrollment in a health maintenance organization or capitated insurance plans reduced early surgery rates by about 14%.

The researchers note that they did not consider patient factors. Burden of disease, especially quality of life or anxiety about future episodes, is a potential factor that may encourage surgeons and patients to consider and accept early surgery.