Diverticulitis is a population health problem: Lessons and gaps in strategies to implement and improve contemporary care

Abstract

The disease burden of diverticulitis is high across inpatient and outpatient settings, and the prevalence of diverticulitis has increased. Historically, patients with acute diverticulitis were admitted routinely for intravenous antibiotics and many had urgent surgery with colostomy or elective surgery after only a few episodes. Several recent studies have challenged the standards of how acute and recurrent diverticulitis are managed, and many clinical practice guidelines (CPGs) have pivoted to recommend outpatient management and individualized decisions about surgery. Yet the rates of diverticulitis hospitalizations and operations are increasing in the United States, suggesting there is a disconnect from or delay in adoption of CPGs across the spectrum of diverticular disease. In this review, we propose approaching diverticulitis care from a population level to understand the gaps between contemporary studies and real-world practice and suggest strategies to implement and improve future care.

Keywords: Diverticulitis; Hospitalization; Elective; Emergent surgery; Clinical guidelines; Diverticular disease

Core Tip: Diverticulitis-associated hospitalization and colectomy are costly and have increased over the past decade, despite professional society guidelines advocating for outpatient management and individualized decisions about surgery. These trends raise flags about how to best measure guideline-concordant clinical practice in the modern era. Strategies to improve guideline-concordant care may consist of improved population-level data in diverticulitis care, regionalization of care, and system wide quality improvement initiatives for guideline implementation.