Thomas Jefferson University Hospital Philadelphia, PA
Brenda French, MD1, Christine Shieh, MD1, Caroline Johnson, MD2; 1Thomas Jefferson University Hospital, Philadelphia, PA; 2Philadelphia Department of Public Health, Philadelphia, PA
Introduction: Due to increased incidence of diverticulitis and its complications creating a burden on the national healthcare system, there has been a shift towards a more conservative approach to treat diverticular disease in the past few years. We aimed to define the effects of these management changes by performing a survey of hospitalizations related to diverticulitis in a large, urban city to better understand recent trends in diverticulitis admissions. Methods: Inpatient data collected by the Pennsylvania Health Care Cost Containment Council (PHC4) was used for retrospective analysis of 20,260 hospitalizations from 2002 to 2018 at acute care hospitals in Philadelphia where the primary diagnosis for admission was diverticulitis. From these admissions, complications were identified by primary or secondary diagnosis codes listing diverticular abscess, hemorrhage, perforation, obstruction, and/or fistula. Results: Between 2002 and 2018, diverticulitis was responsible for 20,260 hospitalizations within Philadelphia. Complicated diverticulitis (n=5,825) surpassed uncomplicated diverticulitis (n=14,425) in recent years with a 46.1% decrease in uncomplicated diverticulitis admissions and a 121.5% increase in complicated diverticulitis admissions. Most change occurred from 2014 onwards (Figure 1). Of the complications, abscesses have increased by 472.7% and represent the most common complication of diverticulitis (n=3,575)(Figure 2). Upon closer analysis, several complications of diverticulitis were positively associated with the occurrence of abscesses. These included perforation (OR=2.60; 95% CI= 1.95-3.46), obstruction (OR=2.25; 95% CI=1.97-2.57), and fistula (OR=9.46; 95% CI=7.24-12.36), but not hemorrhage. Discussion: We hypothesize that the surge in complicated diverticulitis and diverticular abscesses may be due to a failure in conservative management, especially with the movement to discontinue antibiotic use in select uncomplicated diverticulitis cases. This temporal overlap suggests that antibiotics may play a crucial role in preventing long-term complications of acute diverticulitis. In addition, abscesses appear to be strongly associated with all other complications of diverticulitis except for hemorrhage, supporting the notion that abscesses may be a precursor to further sequelae. Therefore, early detection of abscesses is important to prevent progression to more life-threatening complications.
Figure 1. Number of hospitalizations with diverticulitis as primary diagnosis in the Philadelphia area between 2002-2018, further subdivided into uncomplicated and complicated diverticulitis.
Figure 2. Number of hospitalizations with complications of diverticulitis including abscess, perforation, hemorrhage, obstruction, and fistula as primary diagnosis in the Philadelphia area between 2002-2018.
Table 1. Total number, average age (+/- S.D.), and number/percentage female gender of hospitalizations with diverticulitis and its complications in the Philadelphia area from 2002 to 2018.
Disclosures: Brenda French indicated no relevant financial relationships. Christine Shieh indicated no relevant financial relationships. Caroline Johnson indicated no relevant financial relationships.