ABSTRACT
BACKGROUND: Bleeding from a colonic diverticulum is serious in aged patients. The aim of this study was to determine the risk factors for high-cost hospitalization of colonic diverticular bleeding using the diagnosis procedure combination (DPC) data. METHODS: From January 2009 to December 2015, 78 patients with colonic diverticular bleeding were identified by DPC data in Saga Medical School Hospital. All patients underwent colonic endoscopy within 3 days. The patients were divided into 2 groups: the low-cost group (DPC cost of <500,000 yen) and the high-cost group (DPC cost of >500,000 yen). RESULTS: Univariate analysis revealed that aging, hypertension, rebleeding, a low hemoglobin concentration at admission, and blood transfusion were risk factors for high hospitalization cost. Multivariate analysis revealed that rebleeding (OR 5.3; 95% CI 1.3-21.3; p = 0.017) and blood transfusion (OR 3.8; 95% CI 1.01-14.2; p = 0.048) were definite risk factors for high hospitalization cost. CONCLUSION: Rebleeding and blood transfusion were related to high hospitalization cost for colonic diverticular bleeding.
Subject(s)
Colonoscopy/economics , Diverticulum, Colon/economics , Gastrointestinal Hemorrhage/economics , Health Care Costs/statistics & numerical data , Hospitalization/economics , Aged , Aged, 80 and over , Blood Transfusion/economics , Blood Transfusion/statistics & numerical data , Colon/diagnostic imaging , Colon/pathology , Colonoscopy/statistics & numerical data , Diverticulum, Colon/complications , Diverticulum, Colon/diagnosis , Diverticulum, Colon/therapy , Female , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Hemoglobins/analysis , Hospitalization/statistics & numerical data , Humans , Japan , Male , Middle Aged , Retrospective Studies , Risk FactorsABSTRACT
Controversy exists as to the most appropriate management of patients following two episodes of diverticulitis. Despite a growing body of new evidence challenging the concept of elective sigmoid resection after a patient experiences two attacks of diverticulitis, we continue to base our practice on outdated studies carried out more than 30 years ago. The recommendation that patients undergo elective sigmoid resection after two attacks of acute diverticulitis should be re-evaluated as it is generally inappropriate and is not cost effective. Elective resection for uncomplicated diverticulitis does not alter outcome, nor does it decrease mortality or prevent complications of the disease. In fact, based on current literature, 18 patients would have to undergo elective operation to prevent one emergency surgery. This article aims to review the current evidence for elective resection following episodes of diverticular disease and addresses emerging controversies in the management of this disease.