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Risk of Recurrent Disease and Surgery Following an Admission for Acute Diverticulitis

El-Sayed, Charlotte, M.R.C.S1; Radley, Simon, F.R.C.S2; Mytton, Jemma, B.Sc.3; Evison, Felicity, M.Sc.3; Ward, Stephen, T., F.R.C.S2

Diseases of the Colon & Rectum: March 2018 - Volume 61 - Issue 3 - p 382–389
doi: 10.1097/DCR.0000000000000939
Original Contributions: Benign
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BACKGROUND: Diverticular disease accounts for significant morbidity and mortality and may take the form of recurrent episodes of acute diverticulitis. The role of elective surgery is not clearly defined.

OBJECTIVE: This study aimed to define the rate of hospital admission for recurrent acute diverticulitis and risk factors associated with recurrence and surgery.

DESIGN: This is a retrospective population-based cohort study.

SETTINGS: National Health Service hospital admissions for acute diverticulitis in England between April 2006 and March 2011 were reviewed.

PATIENTS: Hospital Episode Statistics data identified adult patients with the first episode of acute diverticulitis (index admission), and then identified recurrent admissions and elective or emergency surgery for acute diverticulitis during a minimum follow-up period of 4 years. Exclusion criteria included previous diagnoses of acute diverticulitis, colorectal cancer, or GI bleeding, and prior colectomy or surgery or death during the index admission.

INTERVENTIONS: There were no interventions.

MAIN OUTCOME MEASURES: The primary outcomes measured were recurrent admissions for acute diverticulitis and patients requiring either elective or emergency surgery during the study period.

RESULTS: Some 65,162 patients were identified with the first episode of acute diverticulitis. The rate of hospital admission for recurrent acute diverticulitis was 11.2%. A logistic regression model examined factors associated with recurrent acute diverticulitis and surgery: patient age, female sex, smoking, obesity, comorbidity score >20, dyslipidemia, and complicated acute diverticulitis increased the risk of recurrent acute diverticulitis. There was an inverse relationship between patient age and recurrence. Similar factors were associated with elective and emergency surgery.

LIMITATIONS: The cases of acute diverticulitis required inpatient management and the use of Hospital Episode Statistics, relying on the accuracy of diagnostic coding.

CONCLUSIONS: This is the largest study assessing the rates of hospital admission for recurrent acute diverticulitis. Knowledge of the rate and risk factors for recurrent acute diverticulitis is required to aid discussion and decision making with patients regarding the need and timing of elective surgery. Some factors associated with recurrence are modifiable; therefore, weight reduction and smoking cessation can be championed. See Video Abstract at http://links.lww.com/DCR/A449.

1 Department of General Surgery, Heart of England NHS Foundation Trust, Good Hope Hospital, Sutton Coldfield, Birmingham, United Kingdom

2 Department of Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom

3 Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Funding/Support: None reported.

Financial Disclosures: None reported.

Presented at the meeting of the Association of Surgeons in Training (ASIT), Liverpool, UK, March 18 to 20, 2016; presented at the meeting of the Association of Surgeons of Great Britain and Ireland (ASGBI), Belfast, Northern Ireland, May 11 to 13, 2016; and poster presentation at the meeting of the Association of Coloproctology Great Britain and Ireland, Edinburgh, Scotland, UK, July 4 to 6, 2016.

Correspondence: Charlotte El-Sayed, M.R.C.S., Department of General Surgery, Heart of England NHS Foundation Trust, Good Hope Hospital, Rectory Rd, Sutton Coldfield, Birmingham B75 7RR, UK. E-mail: c.el-sayed@nhs.net

© 2018 The American Society of Colon and Rectal Surgeons