Readmission for Treatment Failure After Nonoperative Management of Acute Diverticulitis: A Nationwide Readmissions Database Analysis

BACKGROUND: The true incidence of, and risk factors for, readmission for treatment failure after nonoperative management of acute diverticulitis remain poorly understood. OBJECTIVE: The purpose of this study was to describe the incidence and risk factors for readmission for treatment failure after nonoperative management of acute diverticulitis using a large national database. DESIGN: This was a retrospective cohort study. SETTINGS: A representative sample of admissions and discharges from hospitals in the United States captured in the National Readmissions Database were included. PATIENTS: Adult patients (age ≥18 y) admitted with a primary diagnostic of colonic diverticulitis between 2010 and 2015 and who were managed nonoperatively and discharged from hospital alive were included. INTERVENTIONS: Study intervention included nonoperative management, consisting of medical therapy with or without percutaneous drainage. MAIN OUTCOME MEASURES: Readmission for treatment failure (defined as a nonelective readmission for diverticulitis within 90 d of discharge), complicated treatment failure (defined as a treatment failure with complicated diverticulitis), and time-to-treatment failure were measured. RESULTS: In total, 201,384 patients were included. The overall incidence of readmission for treatment failure was 6.6%. Treatment failure was significantly higher among patients with an index episode of acute complicated diverticulitis compared with acute uncom...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Benign Source Type: research

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Conclusion: The triple-staple technique is a safe alternative to the double-staple anastomosis after anterior resection. It also effectively shortens the operating time. PMID: 32054240 [PubMed - as supplied by publisher]
Source: Annals of Coloproctology - Category: Gastroenterology Tags: Ann Coloproctol Source Type: research
Twice in three shifts now I have had to call the radiologist to point out their mistakes, and it has changed patient care radically. 1. 55 year old fatman. "Its gawtta be muh diverticalosis again, doc." LLQ tenderness. Rebound+. I'm worried about perf. Radiology reads "acute diverticulitis at rectosigmoid junction; no abscess or free air." *RING RING!* "Hello? Dr. Mouthbreather? This is Dr. RustedFox. Take a look at Jack Sprat's CT again. You see all that free air around the spleen? Might... Read your CTs, folks.
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Emergency Medicine Source Type: forums
Abstract Evaluation and management of acute lower gastrointestinal bleeding focus on etiologies originating distally to the ligament of Treitz. Diverticular disease is the most common source, accounting for 40% of cases. Hemorrhoids, angiodysplasia, infectious colitis, and inflammatory bowel disease are other common sources. Initial evaluation should focus on obtaining the patient's history and performing a physical examination, including evaluation of hemodynamic status. Subsequent evaluation should be based on the suspected etiology. Most patients should undergo colonoscopy for diagnostic and therapeutic purpose...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
We report on the management of three cases of rectal stump leak and sepsis following urgent Hartmann’s procedure for perforated sigmoid diverticulitis or large bowel obstruction. Two patients had significant risk factors for poor tissue healing. All patients developed features of sepsis and computer tomography scans demonstrated rectal stump leak with adjacent collections. All patients required reoperation for drainage and washout of abscess. An intraperitoneal catheter system was introduced together with drains in order to continue on the ward until tract was formed. There was no mortality and minimal morbidity. The...
Source: Journal of Coloproctology - Category: Gastroenterology Source Type: research
AbstractBackgroundLaparoscopic primary anastomosis (PA) without diversion for diverticulitis has historically been confined to the elective setting. Hartmann ’s procedure is associated with high morbidity rates that might be reduced with less invasive and one-step approaches. The aim of this study was to analyze the results of laparoscopic PA without diversion in Hinchey III perforated diverticulitis.MethodsWe performed a retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic sigmoidectomy for diverticular disease during the period 2000 –2018. The sample was divi...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
CONCLUSIONS: High-quality studies showed that laparoscopic peritoneal lavage was associated with an increased morbidity and that Hartmann procedure was associated with poorer long-term outcomes than primary resection with anastomosis with ileostomy, but Hartmann procedure is still acceptable, especially in high-risk patients.
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Current Status Reviews Source Type: research
Condition:   Diverticulitis Colon Intervention:   Procedure: colon resection, stoma Sponsors:   Uppsala University;   Centrallasarettet Västerås;   Mora Hospital, Landstinget Dalarna;   Uppsala University Hospital;   University Hospital, Linkoeping;   Danderyd Hospital;   Sahlgrenska University Hospital, Sweden;   Stockholm South General Hospital Recruiting
Source: - Category: Research Source Type: clinical trials
AbstractBackgroundEpidemiological studies show an increasing trend of hospitalization for acute diverticulitis (AD), but data regarding the trend in hospitalization for complicated AD in Italy are scarce. The aim of this study was to analyze the Italian trend in hospitalization for complicated AD, from 2008 to 2015.MethodsUsing the Italian Hospital Information System, we identified all patients with complicated colonic AD as a discharge diagnosis. Age- and sex-specific rates for AD as well as type of hospital admission (emergency/elective), type of complication (peritonitis, obstruction, bleeding, abscess, fistula, perfora...
Source: Techniques in Coloproctology - Category: Surgery Source Type: research
Teaching Point: Sigmoid diverticulitis may cause colo-vesical fistula from which intravesical protrusion of a pedunculated colonic polyp is an exceptional event that should not be regarded as a bladder cancer. Published on 2020-01-28 10:55:06
Source: Journal of the Belgian Society of Radiology - Category: Radiology Source Type: research
AbstractDiverticulitis is a common disease in western countries, and its incidence is likely expected to increase over years. The burden of diverticular disease on health systems and resources utilization cannot be underestimated, given the high prevalence of diverticulosis and the rate of patients requiring hospitalization and/or surgery. Minimally invasive colorectal surgery can guarantee several benefits over traditional open surgery, even more prominently in the emergency settings. However, there is moderate to low agreement regarding the use of a minimally invasive approach in patients with perforated diverticular dis...
Source: Updates in Surgery - Category: Surgery Source Type: research
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