Nonoperative management of acute complicated diverticulitis: A retrospective cohort needs-assessment study for home-based management.

Abstract

Acute diverticulitis is a significant financial burden in the United States, costing $2 billion annually. Despite evidence favoring outpatient management for uncomplicated cases, hospitalizations for complicated cases are on the rise. This study aimed to evaluate the suitability of home-based, nonoperative management of acute complicated diverticulitis. This retrospective cohort study was conducted at an academic tertiary care center from January 2018 to March 2022, followed by patient and surgeon surveys conducted from February 2023 to August 2023. Hemodynamically stable adult patients admitted with acute complicated diverticulitis were included. The primary outcome was the proportion of admissions dedicated to clinical observation and drug administration during which no intervention was performed. Among 242 admissions, 59 (24.4%) were excluded for critical illness on presentation. The cohort included 183 (75.6%) admissions for nonoperative management: 53.6% male with mean age of 59.7 ± 14.7 years and Charlson Comorbidity Index 2.2 ± 2.2. Surgical intervention was needed for only 3.3% of patients, whereas 56.8% received clinical observation and intravenous medications alone. Of 1,066 total hospital bed-days generated, 827, 185, and 54 were idle, active, and strict inpatient bed-days, respectively. A survey found 65.1% of these patients were interested in home-based care, with safety concerns being the main reason for disinterest. An additional survey found colorectal surgeons at our institution had a positive perception of home-based management for complicated diverticulitis, but had concerns regarding the impact on their workload. Most admissions for nonoperative management of acute complicated diverticulitis are dedicated to observation and can potentially be treated with home-based care.