通过住院病例定义憩室瘘：一项人群研究。

Defining diverticular fistula through inpatient admissions: a population study.

作者信息

Underhill Joshua, Pinzon Maria C Mora, Ritz Ethan, Grunvald Miles, Jochum Sarah, Becerra Adan, Bhama Anuradha, Govekar Henry, Saclarides Theodore, Hayden Dana

机构信息

Department of Surgery, Section of Colon and Rectal Surgery, Rush University Medical Center, 1750 W. Harrison St., Chicago, IL, 60612, USA.

Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.

出版信息

Surg Endosc. 2023 Jan;37(1):645-652. doi: 10.1007/s00464-022-09504-3. Epub 2022 Aug 25.

DOI:10.1007/s00464-022-09504-3

PMID:36006522

Abstract

BACKGROUND

Diverticular fistula, a pathologic connection from the colon to the skin or another organ, is an uncommon sequela of diverticular disease. It is generally considered an indication for surgery. The current literature is limited in terms of defining the epidemiology of this disease process. This analysis defines the demographics of fistulous diverticular disease on a national level.

METHODS

A retrospective review of the 2018 National Inpatient Sample (NIS) was conducted, using ICD-10 codes for diverticular disease, diverticular-associated fistulas, and associated surgeries. Demographic factors were compared between groups, and several sub-group analyses were performed.

RESULTS

A total of 7,105,498 discharges were recorded: 119,115 (1.68%) with non-fistulizing diverticular disease and 3,843 (0.05%) with diverticular fistula. Patients with diverticular fistula were more likely to be younger (64.7 v 68.2 years, p < .0001) and female (57.3% v 55.4%, p = 0.028) than patients with non-fistulizing disease. They were also more likely to undergo surgery (64.9% v 25.7%, p < .0001), to be admitted electively (44.7% v 12.0%, p < .0001), and to have a longer length of stay (LOS) (mean 8.07 v 5.20 days, p < .0001). Diverticular fistula patients that underwent surgery were more likely to be male (44.8% v 39.0%, p = 0.003), to be admitted electively (65.3% v 6.7%, p < .0001), and to have longer LOS (mean 8.74 v 6.81 days, p < .0001) than those who received medical treatment alone.

CONCLUSION

Diverticular fistula is a rare diagnosis, accounting for 0.05% of total admissions and 3.12% of admissions for diverticular disease. However, this is more common than the previously reported rate of < 0.1% of diverticular disease admissions. While surgery is generally indicated for diverticular fistula, only 64.9% of patients underwent surgical treatment. Although this study is limited by its retrospective nature and use of administrative data, our findings elucidate the prevalence and patterns of inpatient admissions for diverticular fistula in the United States.

摘要

背景

憩室瘘是结肠与皮肤或另一器官之间的病理性连接，是憩室病不常见的后遗症。它通常被视为手术指征。目前关于该疾病进程流行病学定义的文献有限。本分析在国家层面界定了瘘管性憩室病的人口统计学特征。

方法

对2018年国家住院患者样本（NIS）进行回顾性研究，使用国际疾病分类第十版（ICD - 10）编码来识别憩室病、憩室相关瘘管及相关手术。对组间人口统计学因素进行比较，并进行了多项亚组分析。

结果

共记录了7,105,498例出院病例：119,115例（1.68%）为非瘘管性憩室病，3,843例（0.05%）为憩室瘘。与非瘘管性疾病患者相比，憩室瘘患者更年轻（64.7岁对68.2岁，p < 0.0001），女性比例更高（57.3%对55.4%，p = 0.028）。他们也更有可能接受手术（64.9%对25.7%，p < 0.0001），择期入院（44.7%对12.0%，p < 0.0001），住院时间更长（平均8.07天对5.20天，p < 0.0001）。接受手术治疗的憩室瘘患者比仅接受药物治疗的患者更有可能为男性（44.8%对39.0%，p = 0.003），择期入院（65.3%对6.7%，p < 0.0001），住院时间更长（平均8.74天对6.81天，p < 0.0001）。

结论

憩室瘘是一种罕见的诊断，占总入院人数的0.05%，占憩室病入院人数的3.12%。然而，这比之前报道的憩室病入院率<0.1%更为常见。虽然憩室瘘通常需要手术治疗，但只有64.9%的患者接受了手术治疗。尽管本研究受其回顾性性质和行政数据使用的限制，但我们的研究结果阐明了美国憩室瘘住院患者的患病率和模式。