Etzioni David A, Mack Thomas M, Beart Robert W, Kaiser Andreas M
Departments of Colorectal Surgery, University of Southern California, Los Angeles, 90033, USA.
Ann Surg. 2009 Feb;249(2):210-7. doi: 10.1097/SLA.0b013e3181952888.
Diverticular disease imposes an impressive clinical burden to the United States population, with over 300,000 admissions and 1.5 million days of inpatient care annually. Consensus regarding the treatment of diverticulitis has evolved over time, with increasing advocacy of primary anastomosis for acute diverticulitis, and nonoperative treatment of recurrent mild/moderate diverticulitis. We analyzed whether these changes are reflected in patterns of practice in a nationally-representative patient cohort.
We used the 1998 to 2005 nationwide inpatient sample to analyze the care received by 267,000 patients admitted with acute diverticulitis, and 33,500 patients operated electively for diverticulitis. Census data were used to calculate population-based incidence rates of disease and surgical treatment. Weighted logistic regression with cluster adjustment at the hospital level was used for hypothesis testing.
Overall annual age-adjusted admissions for acute diverticulitis increased from 120,500 in 1998 to 151,900 in 2005 (26% increase). Rates of admission increased more rapidly within patients aged 18 to 44 years (82%) and 45 to 74 years (36%). Elective operations for diverticulitis rose from 16,100 to 22,500 per year during the same time period (29%), also with a more rapid increase (73%) in rates of surgery for individuals aged 18 to 44 years. Multivariate analysis found no evidence that primary anastomosis is becoming more commonly used.
We are the first to report dramatic changes in rates of treatment for diverticulitis in the United States. The causes of this emerging disease pattern are unknown, but certainly deserve further investigation. For patients undergoing surgery for acute diverticulitis, there was little change over time in the likelihood of a primary anastomosis.
憩室病给美国人群带来了沉重的临床负担，每年有超过30万例住院病例以及150万住院护理日。随着时间的推移，关于憩室炎治疗的共识不断演变，对急性憩室炎越来越主张进行一期吻合术，对复发性轻度/中度憩室炎则采用非手术治疗。我们分析了这些变化是否反映在全国代表性患者队列的治疗模式中。
我们使用1998年至2005年的全国住院患者样本，分析了267000例因急性憩室炎入院的患者以及33500例因憩室炎接受择期手术的患者所接受的治疗。使用人口普查数据计算基于人群的疾病发病率和手术治疗率。采用医院层面集群调整的加权逻辑回归进行假设检验。
总体而言，急性憩室炎经年龄调整后的年度住院病例数从1998年的120500例增加到2005年的151900例（增加了26%）。18至44岁患者（增加82%）和45至74岁患者（增加36%）的住院率上升更为迅速。同期，憩室炎的择期手术从每年16100例增加到22500例（增加29%），18至44岁个体的手术率上升也更为迅速（增加73%）。多变量分析未发现有证据表明一期吻合术的使用越来越普遍。
我们是首个报告美国憩室炎治疗率发生显著变化的研究。这种新出现的疾病模式的原因尚不清楚，但肯定值得进一步研究。对于接受急性憩室炎手术的患者，一期吻合术的可能性随时间变化不大。
