Diseases of the Colon & Rectum最新文献

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.

Background: Anal cancer disproportionately affects people living with HIV. The Department of Veterans Affairs is the largest single provider of health care to people living with HIV in the United States and recommends all veterans living with HIV be screened for anal cancer annually. There are barriers to developing successful anal cancer screening programs, and screenings within Veterans Affairs have been underused.

Objective: This study aims to identify facilitators to anal cancer screening programs in Veterans Affairs.

Design: This is a qualitative study involving semistructured virtual interviews. Thematic analysis was used to identify themes in the interview data.

Settings: Study participants included Veterans Affairs infectious disease providers and colorectal surgeons who care for veterans living with HIV. Participants were asked to discuss factors that influence anal cancer screenings in Veterans Affairs.

Main outcome measures: Themes were mapped to theoretical constructs and domains related to behavioral change using the Theoretical Domains Framework.

Results: A total of 23 Veterans Affairs providers from all major United States geographical regions were interviewed. Important facilitators identified included access to high-resolution anoscopy and colorectal surgery support. The themes for successful anal cancer screening programs were mapped to 15 behavior-influencing constructs and categorized into 6 domains: 1) knowledge, 2) skills, 3) professional role and identity, 4) goals, 5) environmental context and resources, and 6) social influences.

Limitations: This study involves health care providers who are invested in caring for veterans living with HIV, and their perspectives might not be representative of all Veterans Affairs providers.

Conclusions: Access to a clinician with high-resolution anoscopy training and colorectal surgery support were identified as integral components of a successful anal cancer screening program. This study provides a framework for improving anal cancer screenings in veterans living with HIV by use of evidence-based interventions that incorporate the identified facilitators. See Video Abstract .