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Outpatient Versus Hospitalization Management for Uncomplicated Diverticulitis: A Prospective, Multicenter Randomized Clinical Trial (DIVER Trial)

Biondo, Sebastiano MD, PhD*; Golda, Thomas MD, PhD*; Kreisler, Esther MD, PhD*; Espin, Eloy MD, PhD; Vallribera, Francesc MD, PhD; Oteiza, Fabiola MD, PhD; Codina-Cazador, Antonio MD, PhD§; Pujadas, Marcel MD§; Flor, Blas MD, PhD

doi: 10.1097/SLA.0b013e3182965a11
Randomized Controlled Trials

Objective: We compare the results of 2 different strategies for the management of patients with uncomplicated left colonic diverticulitis and to analyze differences in quality of life and economic costs.

Background: The most frequent standard management of acute uncomplicated diverticulitis still is hospital admission both in Europe and United States.

Methods: This multicenter, randomized controlled trial included patients older than 18 years with acute uncomplicated diverticulitis. All the patients underwent abdominal computed tomography. There were 2 strategies of management: hospitalization (group 1) and outpatient (group 2). The first dose of antibiotic was given intravenously to all patients in the emergency department and then group 1 patients were hospitalized whereas patients in group 2 were discharged. The primary end point was the treatment failure rate of the outpatient protocol and need for hospital admission. The secondary end points included quality-of-life assessment and evaluation of costs.

Results: A total of 132 patients were randomized: 4 patients in group 1 and 3 patients in group 2 presented treatment failure without differences between the groups (P = 0.619). The overall health care cost per episode was 3 times lower in group 2, with savings of €1124.70 per patient. No differences were observed between the groups in terms of quality of life.

Conclusions: Outpatient treatment is safe and effective in selected patients with uncomplicated acute diverticulitis. Outpatient treatment allows important costs saving to the health systems without negative influence on the quality of life of patients with uncomplicated diverticulitis. Trial registration ID: EudraCT number 2008-008452-17.

The most frequent standard management of acute uncomplicated diverticulitis is still through hospital admission. Outpatient treatment is safe and effective in patients with uncomplicated acute diverticulitis who do not present concomitant unstable comorbid conditions, immunosuppression, cognitive, social or psychiatric impairment and persisting vomiting. Outpatient treatment allows important cost savings to health systems without negative influence on the quality of life of patients with uncomplicated diverticulitis.

*Department of General and Digestive Surgery–-Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain

Department of General and Digestive Surgery—Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain

Department of General and Digestive Surgery—Colorectal Unit, Virgen del Camino Hospital, Pamplona, Spain

§Department of General and Digestive Surgery–-Colorectal Unit, Josep Trueta University Hospital, Girona, Spain; and

Surgery—Colorectal Unit, Hospital Clinico Universitario, Valencia, Spain.

Reprints: Sebastiano Biondo, MD, PhD, Department of General and Digestive Surgery, Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain. E-mail: sbn.biondo@gmail.com.

Presented as oral paper in the ESCP 7th Annual Conference September 26–29, 2012, Vienna.

Supported by a grant by the Instituto Carlos III from the Ministry of Health, Government of Spain. FIS Number: PI080989. Noncommercial interests.

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.