Ambulatory management of acute uncomplicated diverticulitis (AmbUDiv study) : a multicentre, propensity score matching study
Mohamedahmed, Ali Yasen Hamid, Mohammed Issa, Mohamed Albendary, Mohamed Sultana, Emiko Zaman, Shafquat Bhandari, Santosh Sarma, Diwakar Ball, William Thomas, Pradeep
Mohamedahmed, Ali Yasen
Hamid, Mohammed
Issa, Mohamed
Albendary, Mohamed
Sultana, Emiko
Zaman, Shafquat
Bhandari, Santosh
Sarma, Diwakar
Ball, William
Thomas, Pradeep
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Affiliation
University Hospitals of Derby and Burton NHS Foundation Trust; Hereford County Hospital; Sandwell and West Birmingham NHS Trust; North West Anglia NHS Trust; et al.
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Publication date
2024-11-18
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Abstract
Introduction: Recent studies have suggested that ambulatory management is feasible for acute uncomplicated diverticulitis (AUD); however, there is still no consensus regarding the most appropriate management settings. This study presents a multi-centre experience of managing patients presenting with AUD, specifically focusing on clinical outcomes and comparing ambulatory treatment with in-patient management. Methods: A retrospective multi-centre study was conducted across four hospitals in the UK and included all adult patients with computed tomography (CT) confirmed (Hinchey grade 1a) acute diverticulitis over a 12-month period (January - December 2022). Patient medical records were followed up for 1-year post-index episode, and outcomes were compared between those treated through the ambulatory pathway versus inpatient treatment using 1:1 propensity score matching (PSM). All statistical analysis was performed using the R Foundation for Statistical Computing, version 4.4. Results: A total of 348 patients with Hinchey 1a acute diverticulitis were included (260 in-patients; 88 ambulatory pathway), of which nearly a third (31.3%) had a recurrent disease. Inpatient management was dominant (74.7%), with a median of 3 days of hospital stay. PSM resulted in 172 patients equally divided between the two care settings. Ambulatory management was associated with a lower readmission rate (P = 0.02 before PSM, P = 0.08 after PSM), comparable surgical (P = 0.57 before PSM, 0% in both groups after PSM) and radiological interventions (P = 0.99 before and after PSM) within one year. In both matched and non-matched groups, a strong association between readmissions and inpatient management was noted in univariate analysis (P = 0.03 before PSM, P = 0.04 after PSM) and multivariate analysis (P = 0.02 before PSM, P = 0.03 after PSM). Conclusion: Our study supports the safety and efficacy of managing patients with AUD through a well-designed ambulatory care pathway. In particular, hospital re-admission rates are lower and other outcomes are non-inferior to in-patient treatment. This has implications for substantial cost-savings and better utilisation of limited healthcare resources.
Citation
Mohamedahmed AY, Hamid M, Issa M, Albendary M, Sultana E, Zaman S, Bhandari S, Sarma D, Ball W, Thomas P, Husain N. Ambulatory management of acute uncomplicated diverticulitis (AmbUDiv study): a multicentre, propensity score matching study. Int J Colorectal Dis. 2024 Nov 18;39(1):184. doi: 10.1007/s00384-024-04759-9
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Article