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National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease

INTRODUCTION: Elective surgery for diverticulitis has evolved over the last decade. We aimed to evaluate the impact of changing practice patterns on postoperative outcomes. We hypothesized that the increased use of laparoscopy, and other management changes, would correlate with a decrease in postope...

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Autores principales: Papageorge, Christina M., Kennedy, Gregory D., Carchman, Evie H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916196/
https://www.ncbi.nlm.nih.gov/pubmed/27120447
http://dx.doi.org/10.1007/s11605-016-3150-y
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author Papageorge, Christina M.
Kennedy, Gregory D.
Carchman, Evie H.
author_facet Papageorge, Christina M.
Kennedy, Gregory D.
Carchman, Evie H.
author_sort Papageorge, Christina M.
collection PubMed
description INTRODUCTION: Elective surgery for diverticulitis has evolved over the last decade. We aimed to evaluate the impact of changing practice patterns on postoperative outcomes. We hypothesized that the increased use of laparoscopy, and other management changes, would correlate with a decrease in postoperative complications. METHODS: Patients undergoing non-emergent surgery for diverticulitis from 2005 to 2013 were selected from the National Surgical Quality Improvement Program (NSQIP) database. We compared patient demographics, comorbidities, and operative approach by year of operation using chi-square tests and investigated temporal trends in postoperative outcomes using univariate, trend, and multivariate analyses. RESULTS: The analytic cohort, which included 29,893 patients, had increasing rates of obesity, advanced age, and higher American Society of Anesthesiologists (ASA) class over the study period. The use of laparoscopy increased significantly from 48 % in 2005/2006 to 70 % in 2013 (p < 0.001), while the rate of stoma creation remained unchanged (10–12 %, p = 0.072). The absolute risk of any postoperative complication decreased by 5.8 % over the study period, driven primarily by a reduction in infectious complications. Year of operation was a significant independent predictor of fewer complications for 2011–2013. CONCLUSION: Despite a trend towards increasing patient complexity, there has been a decline in postoperative morbidity following non-emergent surgery for diverticulitis. This trend coincides with the steadily increasing use of laparoscopy in this population.
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spelling pubmed-49161962016-07-06 National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease Papageorge, Christina M. Kennedy, Gregory D. Carchman, Evie H. J Gastrointest Surg Article INTRODUCTION: Elective surgery for diverticulitis has evolved over the last decade. We aimed to evaluate the impact of changing practice patterns on postoperative outcomes. We hypothesized that the increased use of laparoscopy, and other management changes, would correlate with a decrease in postoperative complications. METHODS: Patients undergoing non-emergent surgery for diverticulitis from 2005 to 2013 were selected from the National Surgical Quality Improvement Program (NSQIP) database. We compared patient demographics, comorbidities, and operative approach by year of operation using chi-square tests and investigated temporal trends in postoperative outcomes using univariate, trend, and multivariate analyses. RESULTS: The analytic cohort, which included 29,893 patients, had increasing rates of obesity, advanced age, and higher American Society of Anesthesiologists (ASA) class over the study period. The use of laparoscopy increased significantly from 48 % in 2005/2006 to 70 % in 2013 (p < 0.001), while the rate of stoma creation remained unchanged (10–12 %, p = 0.072). The absolute risk of any postoperative complication decreased by 5.8 % over the study period, driven primarily by a reduction in infectious complications. Year of operation was a significant independent predictor of fewer complications for 2011–2013. CONCLUSION: Despite a trend towards increasing patient complexity, there has been a decline in postoperative morbidity following non-emergent surgery for diverticulitis. This trend coincides with the steadily increasing use of laparoscopy in this population. Springer US 2016-04-27 2016 /pmc/articles/PMC4916196/ /pubmed/27120447 http://dx.doi.org/10.1007/s11605-016-3150-y Text en © The Author(s) 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Article
Papageorge, Christina M.
Kennedy, Gregory D.
Carchman, Evie H.
National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease
title National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease
title_full National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease
title_fullStr National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease
title_full_unstemmed National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease
title_short National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease
title_sort national trends in short-term outcomes following non-emergent surgery for diverticular disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916196/
https://www.ncbi.nlm.nih.gov/pubmed/27120447
http://dx.doi.org/10.1007/s11605-016-3150-y
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