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Ann Surg. 2014 Sep;260(3):533-8; discussion 538-9. doi: 10.1097/SLA.0000000000000894.

Addressing the appropriateness of elective colon resection for diverticulitis: a report from the SCOAP CERTAIN collaborative.

Author information

1
*Department of Surgery, University of Washington, Seattle †Department of Surgery, Swedish Medical Center, Seattle, WA ‡Surgical Care and Outcomes Assessment Program (SCOAP), Seattle, WA §Department of Surgery, Oregon Health & Science University, Portland ¶Department of Surgery, Madigan Army Medical Center, Tacoma, WA ‖Department of Surgery, Virginia Mason Medical Center, Seattle, WA.

Abstract

OBJECTIVE:

To assess the reported indications for elective colon resection for diverticulitis and concordance with professional guidelines.

BACKGROUND:

Despite modern professional guidelines recommending delay in elective colon resection beyond 2 episodes of uncomplicated diverticulitis, the incidence of elective colectomy has increased dramatically in the last 2 decades. Whether surgeons have changed their threshold for recommending a surgical intervention is unknown. In 2010, Washington State's Surgical Care and Outcomes Assessment Program initiated a benchmarking and education initiative related to the indications for colon resection.

METHODS:

Prospective cohort study evaluating indications from chronic complications (fistula, stricture, bleeding) or the number of previously treated diverticulitis episodes for patients undergoing elective colectomy at 1 of 49 participating hospitals (2010-2013).

RESULTS:

Among 2724 patients (58.7 ± 13 years; 46% men), 29.4% had a chronic complication indication (15.6% fistula, 7.4% stricture, 3.0% bleeding, 5.8% other). For the 70.5% with an episode-based indication, 39.4% had 2 or fewer episodes, 56.5% had 3 to 10 episodes, and 4.1% had more than 10 episodes. Thirty-one percent of patients failed to meet indications for either a chronic complication or 3 or more episodes. Over the 4 years, the proportion of patients with an indication of 3 or more episodes increased from 36.6% to 52.7% (P < 0.001) whereas the proportion of those who failed to meet either clinical or episode-based indications decreased from 38.4% to 26.4% (P < 0.001). The annual rate of emergency resections did not increase significantly, varying from 5.6 to 5.9 per year (P = 0.81).

CONCLUSIONS:

Adherence to a guideline based on 3 or more episodes for elective colectomy increased concurrently with a benchmarking and peer-to-peer messaging initiative. Improving adherence to professional guidelines related to appropriate care is critical and can be facilitated by quality improvement collaboratives.

PMID:
25115429
PMCID:
PMC4160115
DOI:
10.1097/SLA.0000000000000894
[Indexed for MEDLINE]
Free PMC Article

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