Trends in Hospital Admission and Surgical Procedures Following ED visits for Diverticulitis
Introduction: Diverticulitis is a common diagnosis in the emergency department (ED). Outpatient management of diverticulitis is safe in selected patients, yet the rates of admission and surgical procedures following ED visits for diverticulitis are unknown, as are the predictive patient characterist...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2016-06-01
|
| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/3mc992dv |
| _version_ | 1818969195468029952 |
|---|---|
| author | Margaret B. Greenwood-Ericksen Joaquim M. Havens Jiemin Ma Joel S. Weissman Jeremiah D. Schuur |
| author_facet | Margaret B. Greenwood-Ericksen Joaquim M. Havens Jiemin Ma Joel S. Weissman Jeremiah D. Schuur |
| author_sort | Margaret B. Greenwood-Ericksen |
| collection | DOAJ |
| description | Introduction: Diverticulitis is a common diagnosis in the emergency department (ED). Outpatient management of diverticulitis is safe in selected patients, yet the rates of admission and surgical procedures following ED visits for diverticulitis are unknown, as are the predictive patient characteristics. Our goal is to describe trends in admission and surgical procedures following ED visits for diverticulitis, and to determine which patient characteristics predict admission.
Methods: We performed a cross-sectional descriptive analysis using data on ED visits from 2006-2011 to determine change in admission and surgical patterns over time. The Nationwide Emergency Department Sample database, a nationally representative administrative claims dataset, was used to analyze ED visits for diverticulitis. We included patients with a principal diagnosis of diverticulitis (ICD-9 codes 562.11, 562.13). We analyzed the rate of admission and surgery in all admitted patients and in low-risk patients, defined as age <50 with no comorbidities (Elixhauser). We used hierarchical multivariate logistic regression to identify patient characteristics associated with admission for diverticulitis.
Results: From 2006 to 2011 ED visits for diverticulitis increased by 21.3% from 238,248 to 302,612, while the admission rate decreased from 55.7% to 48.5% (-7.2%, 95% CI [–7.78 to -6.62]; p<0.001 for trend). The admission rate among low-risk patients decreased from 35.2% in 2006 to 26.8% in 2011 (-8.4%, 95% CI [–9.6 to –7.2]; p<0.001 for trend). Admission for diverticulitis was independently associated with male gender, comorbid illnesses, higher income and commercial health insurance. The surgical rate decreased from 6.5% in 2006 to 4.7% in 2011 (-1.8%, 95% CI [–2.1 to –1.5]; p<0.001 for trend), and among low-risk patients decreased from 4.0% to 2.2% (- 1.8%, 95% CI [–4.5 to –1.7]; p<0.001 for trend).
Conclusion: From 2006 to 2011 ED visits for diverticulitis increased, while ED admission rates and surgical rates declined, with comorbidity, sociodemographic factors predicting hospitalization. Future work should focus on determining if these differences reflect increased disease prevalence, increased diagnosis, or changes in management. [West J Emerg Med. 2016;17(4):409-417.] |
| first_indexed | 2024-12-20T14:16:44Z |
| format | Article |
| id | doaj.art-aa0ab7d45adb48538949389e19ab472f |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-12-20T14:16:44Z |
| publishDate | 2016-06-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-aa0ab7d45adb48538949389e19ab472f2022-12-21T19:38:01ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182016-06-0117440941710.5811/westjem.2016.4.29757Trends in Hospital Admission and Surgical Procedures Following ED visits for DiverticulitisMargaret B. Greenwood-Ericksen0Joaquim M. Havens1Jiemin Ma2Joel S. Weissman3Jeremiah D. Schuur4Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Boston, MassachusettsHarvard Medical School, Boston, Massachusetts; Brigham and Women’s Hospital, Center for Surgery and Public Health, Department of Surgery, Boston, Massachusetts; Brigham and Women’s Hospital, Division of Trauma, Burns and Surgical Critical Care, Boston, MassachusettsSurveillance and Health Services Research Program, American Cancer Society, Atlanta, GeorgiaHarvard Medical School, Boston, Massachusetts; Brigham and Women’s Hospital, Center for Surgery and Public Health, Department of Surgery, Boston, Massachusetts Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Boston, MassachusettsIntroduction: Diverticulitis is a common diagnosis in the emergency department (ED). Outpatient management of diverticulitis is safe in selected patients, yet the rates of admission and surgical procedures following ED visits for diverticulitis are unknown, as are the predictive patient characteristics. Our goal is to describe trends in admission and surgical procedures following ED visits for diverticulitis, and to determine which patient characteristics predict admission. Methods: We performed a cross-sectional descriptive analysis using data on ED visits from 2006-2011 to determine change in admission and surgical patterns over time. The Nationwide Emergency Department Sample database, a nationally representative administrative claims dataset, was used to analyze ED visits for diverticulitis. We included patients with a principal diagnosis of diverticulitis (ICD-9 codes 562.11, 562.13). We analyzed the rate of admission and surgery in all admitted patients and in low-risk patients, defined as age <50 with no comorbidities (Elixhauser). We used hierarchical multivariate logistic regression to identify patient characteristics associated with admission for diverticulitis. Results: From 2006 to 2011 ED visits for diverticulitis increased by 21.3% from 238,248 to 302,612, while the admission rate decreased from 55.7% to 48.5% (-7.2%, 95% CI [–7.78 to -6.62]; p<0.001 for trend). The admission rate among low-risk patients decreased from 35.2% in 2006 to 26.8% in 2011 (-8.4%, 95% CI [–9.6 to –7.2]; p<0.001 for trend). Admission for diverticulitis was independently associated with male gender, comorbid illnesses, higher income and commercial health insurance. The surgical rate decreased from 6.5% in 2006 to 4.7% in 2011 (-1.8%, 95% CI [–2.1 to –1.5]; p<0.001 for trend), and among low-risk patients decreased from 4.0% to 2.2% (- 1.8%, 95% CI [–4.5 to –1.7]; p<0.001 for trend). Conclusion: From 2006 to 2011 ED visits for diverticulitis increased, while ED admission rates and surgical rates declined, with comorbidity, sociodemographic factors predicting hospitalization. Future work should focus on determining if these differences reflect increased disease prevalence, increased diagnosis, or changes in management. [West J Emerg Med. 2016;17(4):409-417.]http://escholarship.org/uc/item/3mc992dvHospital AdmissionSurgical ProceduresDiverticulitis |
| spellingShingle | Margaret B. Greenwood-Ericksen Joaquim M. Havens Jiemin Ma Joel S. Weissman Jeremiah D. Schuur Trends in Hospital Admission and Surgical Procedures Following ED visits for Diverticulitis Western Journal of Emergency Medicine Hospital Admission Surgical Procedures Diverticulitis |
| title | Trends in Hospital Admission and Surgical Procedures Following ED visits for Diverticulitis |
| title_full | Trends in Hospital Admission and Surgical Procedures Following ED visits for Diverticulitis |
| title_fullStr | Trends in Hospital Admission and Surgical Procedures Following ED visits for Diverticulitis |
| title_full_unstemmed | Trends in Hospital Admission and Surgical Procedures Following ED visits for Diverticulitis |
| title_short | Trends in Hospital Admission and Surgical Procedures Following ED visits for Diverticulitis |
| title_sort | trends in hospital admission and surgical procedures following ed visits for diverticulitis |
| topic | Hospital Admission Surgical Procedures Diverticulitis |
| url | http://escholarship.org/uc/item/3mc992dv |
| work_keys_str_mv | AT margaretbgreenwoodericksen trendsinhospitaladmissionandsurgicalproceduresfollowingedvisitsfordiverticulitis AT joaquimmhavens trendsinhospitaladmissionandsurgicalproceduresfollowingedvisitsfordiverticulitis AT jieminma trendsinhospitaladmissionandsurgicalproceduresfollowingedvisitsfordiverticulitis AT joelsweissman trendsinhospitaladmissionandsurgicalproceduresfollowingedvisitsfordiverticulitis AT jeremiahdschuur trendsinhospitaladmissionandsurgicalproceduresfollowingedvisitsfordiverticulitis |