Epworth Healthcare, Melbourne, Victoria, Australia.
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Oct;91(10):2106-2109. doi: 10.1111/ans.16901. Epub 2021 Apr 27.
The traditional approach to management of acute uncomplicated diverticulitis involves admission to hospital, antibiotic therapy, gut rest and monitoring for the development of complications. Despite evidence to suggest this can safely be performed in an outpatient setting, inpatient care remains standard practice in Australia potentially due to a variety of factors (van Dijk et al. 2018; Cirocchi et al. 2019). Hospital in the home (HIH) allows patients requiring complex care including intravenous antibiotics, intravenous fluids and complex pain relief to be managed at home. This study examined the safety and efficacy of HIH-based care for acute diverticulitis over a 16-year period.
A retrospective review of cases of acute diverticulitis managed under our HIH service from the period of 1st of January 2004 to 20th of October 2020 was completed. Baseline descriptive data relating to age, co-morbidities and severity of diverticulitis was collected. Details of medical treatment provided and subsequent complications were also collected.
During the study period, 23 patients with acute diverticulitis were treated under the HIH unit. Among the study population, the median age was 60 (interquartile range 15) with a slight female predominance (n = 13, 56.5%). This represented the first presentation in 60.9% of patients. Average length of stay was 3.6 days (SD = 1.0) with no acute complications recorded in the study period. Two patients (8.7%) had further episodes of acute diverticulitis within 60 days.
In this study, the lack of complications demonstrated indicates that HIH-based management of acute diverticulitis may be a viable and safe alternative to inpatient care.
传统的急性单纯性憩室炎管理方法包括住院、抗生素治疗、肠道休息和监测并发症的发生。尽管有证据表明这种方法可以在门诊环境中安全进行，但住院治疗仍然是澳大利亚的标准做法，这可能是由于多种因素造成的（van Dijk 等人，2018 年；Cirocchi 等人，2019 年）。家庭医院（HIH）允许需要复杂护理的患者在家中接受治疗，包括静脉抗生素、静脉补液和复杂的止痛治疗。本研究在 16 年期间检查了基于 HIH 的急性憩室炎护理的安全性和疗效。
对 2004 年 1 月 1 日至 2020 年 10 月 20 日期间在我们的 HIH 服务下管理的急性憩室炎病例进行了回顾性审查。收集了与年龄、合并症和憩室炎严重程度相关的基线描述性数据。还收集了提供的医疗治疗细节和随后的并发症。
在研究期间，23 名急性憩室炎患者在 HIH 病房接受治疗。在研究人群中，中位数年龄为 60 岁（四分位距 15），女性略占优势（n=13，56.5%）。这代表了 60.9%的患者的首次就诊。平均住院时间为 3.6 天（标准差=1.0），研究期间无急性并发症记录。2 名患者（8.7%）在 60 天内再次发生急性憩室炎。
在本研究中，缺乏并发症表明，基于 HIH 的急性憩室炎管理可能是住院治疗的一种可行且安全的替代方法。
