National Trends in Hospital Admissions, Interventions and Outcomes for Early-Onset (Age <50) Diverticulitis From 2005-2020.

Abstract

Background: Little is known about the burden and outcomes of diverticulitis in patients under the age of 50. This knowledge gap hinders the development of effective management strategies and preventive measures for this population.

Objective: This study aimed to analyze national trends in hospitalizations, interventions, and outcomes for early-onset (age <50) diverticulitis in comparison to standard-onset (age ≥50) cohorts.

Design: Retrospective cohort study.

Settings: A survey-weighted, national sample extracted from the National Inpatient Sample.

Patients: All adults (≥ 18 years) hospitalized for diverticulitis between 2005 and 2020.

Main outcome measures: National trends in the proportions of early-onset vs. standard-onset diverticulitis related, along with the rates of colectomy.

Results: From 2005-2020, 5,239,735 patients were electively hospitalized for diverticulitis. 837,195 (16.0%) were early onset. During the study period, the proportion of Early-onset cohort admitted for complicated-diverticulitis significantly increased from 18.5% to 28.2% (nptrend < 0.001) Additionally, there was a decline in the proportion of early-onset diverticulitis patients needing a colectomy (34.7% to 20.3%, nptrend < 0.001), with a corresponding increase in the proportion of patients needing Interventional Radiology intervention (12.7% to 28.6%, nptrend < 0.001). Compared to standard-onset diverticulitis, early-onset diverticulitis was associated with decreased odds of mortality (Adjusted Odds Ratio [AOR] 0.18, 95% Confidence Interval (95% CI) 0.16-0.20, p < 0.001) as well as decreased length of stay (β -0.28 days, 95% CI [-0.32,-0.24], p < 0.001) and hospitalization costs (β -$1,900, 95%CI [-$2,100,-$1,800], p < 0.001). Additionally, early-onset diverticulitis was associated with increased odds of colectomy (AOR 1.29, 95%CI 1.26-1.31) and percutaneous drainage (AOR 1.58, 95% CI 1.53-1.62).

Limitations: Retrospective data collection. Lack of granular clinical data.

Conclusion: There has been a significant increase in the proportion of complicated-diverticulitis related admissions among patients under 50. Patients with early-onset diverticulitis were more likely to undergo colectomy or percutaneous drainage than those with standard-onset (≥50 years) diverticulitis. Future work is needed to determine the cause for these trends and identify public health policies aimed at potential preventing the increasing burden of diverticulitis among younger populations. See Video Abstract.