WTP4.7 Evidence-Based care for Acute Uncomplicated Colonic Diverticulitis. Effects on Bed Occupancy, Broad Spectrum Antibiotic Therapy and Cost savings
Sayantan Bose, Derek McWhirter, Gordon Carlson- Surgery
Abstract
Aims
To investigate the impact of failure to adhere to best-practice guidelines in the management of acute uncomplicated colonic diverticulitis on use of hospital resources.
Methods
Retrospective study from January 2019 till December 2021. The clinical pathway, including disposal (admission vs discharge), imaging, time course, illness severity, treatment and outcome of all adult patients (18 years and older) attending as an emergency with acute colonic diverticulitis were identified from ICD-10 coding data. All radiology reports were reviewed and a modified Hinchey classification of disease severity recorded.
Results
339 patients were identified during the study period. 79 were excluded because of incorrect coding. In 260 cases (222 patients) median (range) age 56 (23-92) years, the diagnosis was confirmed by CT scan in 247 (95%). Of these, 174 (67%) had uncomplicated (Hinchey 1a) acute colonic diverticulitis. 235 (90%) of all attendances resulted in an acute hospital admission. However, 149/174 (86%) of all patients with Hinchey 1a disease were admitted to hospital and 142 of these (95.3%) were treated with broad spectrum IV antibiotics, despite evidence-based guidance indicating that this treatment is unnecessary. 605/1268 (48%) of all bed days for the management of acute diverticulitis over the study period were used to treat patients with Hinchey 1a disease.
Conclusion
Almost half of all patients admitted with acute diverticulitis could have been managed on ambulatory pathways without antibiotics. Adherence to evidence-based guidance and development of appropriate patient pathways provide an opportunity for considerable improvements in efficient use of hospital resources and improved antibiotic stewardship.