TY - JOUR
T1 - A systematic review and meta-analysis of outpatient treatment for acute diverticulitis
AU - van Dijk, S. T.
AU - Bos, K.
AU - de Boer, M. G. J.
AU - Draaisma, W. A.
AU - van Enst, W. A.
AU - Felt, R. J. F.
AU - Klarenbeek, B. R.
AU - Otte, J. A.
AU - Puylaert, J. B. C. M.
AU - van Geloven, A. A. W.
AU - Boermeester, M. A.
PY - 2018
Y1 - 2018
N2 - Background: The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient treatment, potentially reducing the burden of one of the most common gastrointestinal diseases in the Western world. Purpose: Assessing the safety and cost savings of outpatient treatment in acute colonic diverticulitis. Methods: PubMed and EMBASE were searched for studies on outpatient treatment of colonic diverticulitis, confirmed with computed tomography or ultrasound. Outcomes were readmission rate, need for emergency surgery or percutaneous abscess drainage, and healthcare costs. Results: A total of 19 studies with 2303 outpatient treated patients were included. These studies predominantly excluded patients with comorbidity or immunosuppression, inability to tolerate oral intake, or lack of an adequate social network. The pooled incidence rate of readmission for outpatient treatment was 7% (95%CI 6–9%, I2 48%). Only 0.2% (2/1288) of patients underwent emergency surgery, and 0.2% (2/1082) of patients underwent percutaneous abscess drainage. Only two studies compared readmission rates outpatients that had similar characteristics as a control group of inpatients; 4.5% (3/66) and 6.3% (2/32) readmissions in outpatient groups versus 6.1% (4/66) and 0.0% (0/44) readmissions in inpatient groups (p = 0.619 and p = 0.174, respectively). Average healthcare cost savings for outpatient compared with inpatient treatment ranged between 42 and 82%. Conclusion: Outpatient treatment of uncomplicated diverticulitis resulted in low readmission rates and very low rates of complications. Furthermore, healthcare cost savings were substantial. Therefore, outpatient treatment of uncomplicated diverticulitis seems to be a safe option for most patients.
AB - Background: The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient treatment, potentially reducing the burden of one of the most common gastrointestinal diseases in the Western world. Purpose: Assessing the safety and cost savings of outpatient treatment in acute colonic diverticulitis. Methods: PubMed and EMBASE were searched for studies on outpatient treatment of colonic diverticulitis, confirmed with computed tomography or ultrasound. Outcomes were readmission rate, need for emergency surgery or percutaneous abscess drainage, and healthcare costs. Results: A total of 19 studies with 2303 outpatient treated patients were included. These studies predominantly excluded patients with comorbidity or immunosuppression, inability to tolerate oral intake, or lack of an adequate social network. The pooled incidence rate of readmission for outpatient treatment was 7% (95%CI 6–9%, I2 48%). Only 0.2% (2/1288) of patients underwent emergency surgery, and 0.2% (2/1082) of patients underwent percutaneous abscess drainage. Only two studies compared readmission rates outpatients that had similar characteristics as a control group of inpatients; 4.5% (3/66) and 6.3% (2/32) readmissions in outpatient groups versus 6.1% (4/66) and 0.0% (0/44) readmissions in inpatient groups (p = 0.619 and p = 0.174, respectively). Average healthcare cost savings for outpatient compared with inpatient treatment ranged between 42 and 82%. Conclusion: Outpatient treatment of uncomplicated diverticulitis resulted in low readmission rates and very low rates of complications. Furthermore, healthcare cost savings were substantial. Therefore, outpatient treatment of uncomplicated diverticulitis seems to be a safe option for most patients.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85043456387&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29532202
U2 - https://doi.org/10.1007/s00384-018-3015-9
DO - https://doi.org/10.1007/s00384-018-3015-9
M3 - Review article
C2 - 29532202
SN - 0179-1958
VL - 33
SP - 505
EP - 512
JO - International journal of colorectal disease
JF - International journal of colorectal disease
IS - 5
ER -