Addressing the appropriateness of elective colon resection for diverticulitis

A report from the SCOAP CERTAIN collaborative

Vlad V. Simianu, Amir L. Bastawrous, Richard P. Billingham, Ellen T. Farrokhi, Alessandro Fichera, Daniel Herzig, Eric Johnson, Scott R. Steele, Richard C. Thirlby, David R. Flum

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: To assess the reported indications for elective colon resection for diverticulitis and concordance with professional guidelines. Background: Despite modern professional guidelines recommending delay in elective colon resection beyond 2 episodes of uncomplicated diverticulitis, the incidence of elective colectomy has increased dramatically in the last 2 decades. Whether surgeons have changed their threshold for recommending a surgical intervention is unknown. In 2010, Washington State's Surgical Care and Outcomes Assessment Program initiated a benchmarking and education initiative related to the indications for colon resection. Methods: Prospective cohort study evaluating indications from chronic complications (fistula, stricture, bleeding) or the number of previously treated diverticulitis episodes for patients undergoing elective colectomy at 1 of 49 participating hospitals (2010-2013). Results: Among 2724 patients (58.7 ± 13 years; 46% men), 29.4% had a chronic complication indication (15.6% fistula, 7.4% stricture, 3.0% bleeding, 5.8% other). For the 70.5% with an episode-based indication, 39.4% had 2 or fewer episodes, 56.5% had 3 to 10 episodes, and 4.1% had more than 10 episodes. Thirty-one percent of patients failed to meet indications for either a chronic complication or 3 or more episodes. Over the 4 years, the proportion of patients with an indication of 3 or more episodes increased from 36.6% to 52.7% (P <0.001) whereas the proportion of those who failed to meet either clinical or episode-based indications decreased from 38.4% to 26.4% (P <0.001). The annual rate of emergency resections did not increase significantly, varying from 5.6 to 5.9 per year (P = 0.81). Conclusions: Adherence to a guideline based on 3 or more episodes for elective colectomy increased concurrently with a benchmarking and peer-to-peer messaging initiative. Improving adherence to professional guidelines related to appropriate care is critical and can be facilitated by quality improvement collaboratives.

Original languageEnglish (US)
Pages (from-to)533-539
Number of pages7
JournalAnnals of Surgery
Volume260
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Diverticulitis
Colectomy
Colon
Guidelines
Benchmarking
Fistula
Pathologic Constriction
Hemorrhage
Critical Care
Quality Improvement
Emergencies
Cohort Studies
Outcome Assessment (Health Care)
Prospective Studies
Education
Incidence

Keywords

  • appropriateness
  • benchmarking
  • diverticulitis
  • elective colectomy
  • guidelines

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Addressing the appropriateness of elective colon resection for diverticulitis : A report from the SCOAP CERTAIN collaborative. / Simianu, Vlad V.; Bastawrous, Amir L.; Billingham, Richard P.; Farrokhi, Ellen T.; Fichera, Alessandro; Herzig, Daniel; Johnson, Eric; Steele, Scott R.; Thirlby, Richard C.; Flum, David R.

In: Annals of Surgery, Vol. 260, No. 3, 2014, p. 533-539.

Research output: Contribution to journalArticle

Simianu, VV, Bastawrous, AL, Billingham, RP, Farrokhi, ET, Fichera, A, Herzig, D, Johnson, E, Steele, SR, Thirlby, RC & Flum, DR 2014, 'Addressing the appropriateness of elective colon resection for diverticulitis: A report from the SCOAP CERTAIN collaborative', Annals of Surgery, vol. 260, no. 3, pp. 533-539. https://doi.org/10.1097/SLA.0000000000000894
Simianu, Vlad V. ; Bastawrous, Amir L. ; Billingham, Richard P. ; Farrokhi, Ellen T. ; Fichera, Alessandro ; Herzig, Daniel ; Johnson, Eric ; Steele, Scott R. ; Thirlby, Richard C. ; Flum, David R. / Addressing the appropriateness of elective colon resection for diverticulitis : A report from the SCOAP CERTAIN collaborative. In: Annals of Surgery. 2014 ; Vol. 260, No. 3. pp. 533-539.
@article{141b37e330be4f739293633a323ffb21,
title = "Addressing the appropriateness of elective colon resection for diverticulitis: A report from the SCOAP CERTAIN collaborative",
abstract = "Objective: To assess the reported indications for elective colon resection for diverticulitis and concordance with professional guidelines. Background: Despite modern professional guidelines recommending delay in elective colon resection beyond 2 episodes of uncomplicated diverticulitis, the incidence of elective colectomy has increased dramatically in the last 2 decades. Whether surgeons have changed their threshold for recommending a surgical intervention is unknown. In 2010, Washington State's Surgical Care and Outcomes Assessment Program initiated a benchmarking and education initiative related to the indications for colon resection. Methods: Prospective cohort study evaluating indications from chronic complications (fistula, stricture, bleeding) or the number of previously treated diverticulitis episodes for patients undergoing elective colectomy at 1 of 49 participating hospitals (2010-2013). Results: Among 2724 patients (58.7 ± 13 years; 46{\%} men), 29.4{\%} had a chronic complication indication (15.6{\%} fistula, 7.4{\%} stricture, 3.0{\%} bleeding, 5.8{\%} other). For the 70.5{\%} with an episode-based indication, 39.4{\%} had 2 or fewer episodes, 56.5{\%} had 3 to 10 episodes, and 4.1{\%} had more than 10 episodes. Thirty-one percent of patients failed to meet indications for either a chronic complication or 3 or more episodes. Over the 4 years, the proportion of patients with an indication of 3 or more episodes increased from 36.6{\%} to 52.7{\%} (P <0.001) whereas the proportion of those who failed to meet either clinical or episode-based indications decreased from 38.4{\%} to 26.4{\%} (P <0.001). The annual rate of emergency resections did not increase significantly, varying from 5.6 to 5.9 per year (P = 0.81). Conclusions: Adherence to a guideline based on 3 or more episodes for elective colectomy increased concurrently with a benchmarking and peer-to-peer messaging initiative. Improving adherence to professional guidelines related to appropriate care is critical and can be facilitated by quality improvement collaboratives.",
keywords = "appropriateness, benchmarking, diverticulitis, elective colectomy, guidelines",
author = "Simianu, {Vlad V.} and Bastawrous, {Amir L.} and Billingham, {Richard P.} and Farrokhi, {Ellen T.} and Alessandro Fichera and Daniel Herzig and Eric Johnson and Steele, {Scott R.} and Thirlby, {Richard C.} and Flum, {David R.}",
year = "2014",
doi = "10.1097/SLA.0000000000000894",
language = "English (US)",
volume = "260",
pages = "533--539",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Addressing the appropriateness of elective colon resection for diverticulitis

T2 - A report from the SCOAP CERTAIN collaborative

AU - Simianu, Vlad V.

AU - Bastawrous, Amir L.

AU - Billingham, Richard P.

AU - Farrokhi, Ellen T.

AU - Fichera, Alessandro

AU - Herzig, Daniel

AU - Johnson, Eric

AU - Steele, Scott R.

AU - Thirlby, Richard C.

AU - Flum, David R.

PY - 2014

Y1 - 2014

N2 - Objective: To assess the reported indications for elective colon resection for diverticulitis and concordance with professional guidelines. Background: Despite modern professional guidelines recommending delay in elective colon resection beyond 2 episodes of uncomplicated diverticulitis, the incidence of elective colectomy has increased dramatically in the last 2 decades. Whether surgeons have changed their threshold for recommending a surgical intervention is unknown. In 2010, Washington State's Surgical Care and Outcomes Assessment Program initiated a benchmarking and education initiative related to the indications for colon resection. Methods: Prospective cohort study evaluating indications from chronic complications (fistula, stricture, bleeding) or the number of previously treated diverticulitis episodes for patients undergoing elective colectomy at 1 of 49 participating hospitals (2010-2013). Results: Among 2724 patients (58.7 ± 13 years; 46% men), 29.4% had a chronic complication indication (15.6% fistula, 7.4% stricture, 3.0% bleeding, 5.8% other). For the 70.5% with an episode-based indication, 39.4% had 2 or fewer episodes, 56.5% had 3 to 10 episodes, and 4.1% had more than 10 episodes. Thirty-one percent of patients failed to meet indications for either a chronic complication or 3 or more episodes. Over the 4 years, the proportion of patients with an indication of 3 or more episodes increased from 36.6% to 52.7% (P <0.001) whereas the proportion of those who failed to meet either clinical or episode-based indications decreased from 38.4% to 26.4% (P <0.001). The annual rate of emergency resections did not increase significantly, varying from 5.6 to 5.9 per year (P = 0.81). Conclusions: Adherence to a guideline based on 3 or more episodes for elective colectomy increased concurrently with a benchmarking and peer-to-peer messaging initiative. Improving adherence to professional guidelines related to appropriate care is critical and can be facilitated by quality improvement collaboratives.

AB - Objective: To assess the reported indications for elective colon resection for diverticulitis and concordance with professional guidelines. Background: Despite modern professional guidelines recommending delay in elective colon resection beyond 2 episodes of uncomplicated diverticulitis, the incidence of elective colectomy has increased dramatically in the last 2 decades. Whether surgeons have changed their threshold for recommending a surgical intervention is unknown. In 2010, Washington State's Surgical Care and Outcomes Assessment Program initiated a benchmarking and education initiative related to the indications for colon resection. Methods: Prospective cohort study evaluating indications from chronic complications (fistula, stricture, bleeding) or the number of previously treated diverticulitis episodes for patients undergoing elective colectomy at 1 of 49 participating hospitals (2010-2013). Results: Among 2724 patients (58.7 ± 13 years; 46% men), 29.4% had a chronic complication indication (15.6% fistula, 7.4% stricture, 3.0% bleeding, 5.8% other). For the 70.5% with an episode-based indication, 39.4% had 2 or fewer episodes, 56.5% had 3 to 10 episodes, and 4.1% had more than 10 episodes. Thirty-one percent of patients failed to meet indications for either a chronic complication or 3 or more episodes. Over the 4 years, the proportion of patients with an indication of 3 or more episodes increased from 36.6% to 52.7% (P <0.001) whereas the proportion of those who failed to meet either clinical or episode-based indications decreased from 38.4% to 26.4% (P <0.001). The annual rate of emergency resections did not increase significantly, varying from 5.6 to 5.9 per year (P = 0.81). Conclusions: Adherence to a guideline based on 3 or more episodes for elective colectomy increased concurrently with a benchmarking and peer-to-peer messaging initiative. Improving adherence to professional guidelines related to appropriate care is critical and can be facilitated by quality improvement collaboratives.

KW - appropriateness

KW - benchmarking

KW - diverticulitis

KW - elective colectomy

KW - guidelines

UR - http://www.scopus.com/inward/record.url?scp=84906043410&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906043410&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000000894

DO - 10.1097/SLA.0000000000000894

M3 - Article

VL - 260

SP - 533

EP - 539

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -