A systematic review and meta-analysis of outpatient treatment for acute diverticulitis

S. T. van Dijk, K. Bos, M. G. J. de Boer, W. A. Draaisma, W. A. van Enst, R. J. F. Felt, B. R. Klarenbeek, J. A. Otte, J. B. C. M. Puylaert, A. A. W. van Geloven, M. A. Boermeester

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)505-512
JournalInternational Journal of Colorectal Disease
Volume33
Issue number5
DOIs
Publication statusPublished - 2018

Cite this

van Dijk, S. T., Bos, K., de Boer, M. G. J., Draaisma, W. A., van Enst, W. A., Felt, R. J. F., ... Boermeester, M. A. (2018). A systematic review and meta-analysis of outpatient treatment for acute diverticulitis. International Journal of Colorectal Disease, 33(5), 505-512. https://doi.org/10.1007/s00384-018-3015-9
van Dijk, S. T. ; Bos, K. ; de Boer, M. G. J. ; Draaisma, W. A. ; van Enst, W. A. ; Felt, R. J. F. ; Klarenbeek, B. R. ; Otte, J. A. ; Puylaert, J. B. C. M. ; van Geloven, A. A. W. ; Boermeester, M. A. / A systematic review and meta-analysis of outpatient treatment for acute diverticulitis. In: International Journal of Colorectal Disease. 2018 ; Vol. 33, No. 5. pp. 505-512.
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title = "A systematic review and meta-analysis of outpatient treatment for acute diverticulitis",
abstract = "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.",
author = "{van Dijk}, {S. T.} and K. Bos and {de Boer}, {M. G. J.} and Draaisma, {W. A.} and {van Enst}, {W. A.} and Felt, {R. J. F.} and Klarenbeek, {B. R.} and Otte, {J. A.} and Puylaert, {J. B. C. M.} and {van Geloven}, {A. A. W.} and Boermeester, {M. A.}",
year = "2018",
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van Dijk, ST, Bos, K, de Boer, MGJ, Draaisma, WA, van Enst, WA, Felt, RJF, Klarenbeek, BR, Otte, JA, Puylaert, JBCM, van Geloven, AAW & Boermeester, MA 2018, 'A systematic review and meta-analysis of outpatient treatment for acute diverticulitis' International Journal of Colorectal Disease, vol. 33, no. 5, pp. 505-512. https://doi.org/10.1007/s00384-018-3015-9

A systematic review and meta-analysis of outpatient treatment for acute diverticulitis. / van Dijk, S. T.; Bos, K.; de Boer, M. G. J.; Draaisma, W. A.; van Enst, W. A.; Felt, R. J. F.; Klarenbeek, B. R.; Otte, J. A.; Puylaert, J. B. C. M.; van Geloven, A. A. W.; Boermeester, M. A.

In: International Journal of Colorectal Disease, Vol. 33, No. 5, 2018, p. 505-512.

Research output: Contribution to journalReview articleAcademicpeer-review

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.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/29532202

U2 - 10.1007/s00384-018-3015-9

DO - 10.1007/s00384-018-3015-9

M3 - Review article

VL - 33

SP - 505

EP - 512

JO - International Journal of Colorectal Disease

JF - International Journal of Colorectal Disease

SN - 0179-1958

IS - 5

ER -