Practice Patterns and Impact of Operative and Non-operative Management of Diverticulitis

憩室炎手术和非手术治疗的实践模式和影响

• 批准号: 8963342
• 负责人: David R Flum
• 金额: $ 57.35万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8963342
• 关键词: Acute; Address; Adoption; Age; Age-Years; American; Antibiotics; Anxiety; Automobile Driving; Caring; Characteristics; Clinic; Clinical; Colectomy; Colon; Colostomy Procedure; Comparative Study; Counseling; Data; Databases; Decision Making; Development; Disease; Diverticulitis; Diverticulosis; Effectiveness; Emergency Situation; Evaluation; Event; Excision; Future; Growth; Guidelines; Hospitals; Incidence; Inpatients; Intervention; Laparoscopic Surgical Procedures; Laparoscopy; Link; Measures; Morbidity - disease rate; Motivation; Operative Surgical Procedures; Oral; Outcome; Outpatients; Pain; Patient Outcomes Assessments; Patient Self-Report; Patient-Centered Care; Patients; Pattern; Patterns of Care; Population; Practice Guidelines; Procedures; Professional Organizations; Recommendation; Recovery; Recruitment Activity; Recurrence; Reporting; Research; Residual state; Risk; Social support; Societies; Surgeon; Symptoms; Testing; Time; Training; Uncertainty; Washington; Work; base; burden of illness; cohort; comparative; gastrointestinal; instrument; interest; lifetime risk; novel; novel strategies; older patient; operation; patient oriented; patient registry; prophylactic; public health relevance; trend

 DESCRIPTION (provided by applicant): Half of all Americans over the age of 60 have diverticulosis of the colon, and 20-25% are expected to develop acute diverticulitis. While most episodes resolve with antibiotics alone, 10-20% will have an emergency colectomy/colostomy at their initial presentation and all patients remain at lifetime risk for recurrent episodes. Given te uncertainty of when and where a recurrent episode will occur and the looming risk of colostomy, surgeons have been trained to recommend elective, "prophylactic" colectomy after 2 episodes, and earlier for those < 50 years. As a result, diverticulitis is now one of the leading reasons for elective colectomy. However, counseling patients after recovering from an episode of diverticulitis is challenging because less than 5% will go on to need emergency surgery and the major morbidity (5%) and recurrence rate (5-11%) after elective resection is not trivial. Several professional societies have now recommended delaying elective resection and called for research to determine its value. Despite these cautions, over the last decade the use of elective resection has increased more than 50%. Elective resections are rising at a much faster rate than the incidence of diverticulitis, coinciding with the widespread adoption of laparoscopy. Given this unexpected trend, it is important to assess the patterns of practice related to early or delayed resection, factors driving decision making, and the impact of the disease on those who do and do not have an elective resection. To address these issues we propose 3 related, but independent studies that describe treatment patterns after recovery from an episode of acute diverticulitis, the factors associated with early and delayed elective surgery, and outcomes and impact of the disease. Aim 1 uses national claims data for a population-level assessment of current patterns of care related to numbers of episodes of treated diverticulitis prior to elective resection. Aim 2 compare how often patients undergoing early versus delayed resection and young vs old report clinical and non-clinical factors as the reason for elective resection. Information from this group about decision making related to elective resection may help explain practice patterns identified in Aim 1. To assess the impact of diverticulitis on all those with the condition, Aim 3 involves a statewide cohort of all patients who recover from an episode of confirmed diverticulitis, assessing how often patients have symptoms related to diverticulitis, patient-reported outcomes, and the burden of the disease over time. Together these studies will determine if the observed, dramatic increase in the use of elective surgery for diverticulitis is consistent with recommendations about delayed intervention, provide better understanding about the factors associated with decisions for elective surgery and provide critical information about the impact of diverticulitis. This information will be helpful in crafting interventions aime at more patient-centered and value-added care and inform decision making. This information will also be critical in the development of comparative studies of colon resection and other treatments for diverticulitis.

 描述（由适用提供）：60岁以上的所有美国人中有一半患有结肠的憩室病，预计20-25％会出现急性憩室炎。虽然大多数发作仅使用抗生素解决，但10-20％的最初介绍将有紧急收集/结肠造口术，并且所有患者仍处于复发性发作的终生风险。考虑到将发生何时何地发生何时何地发生肺切开术的风险，因此已经对外科医生进行了培训，以推荐2次发作后的选修“预防”收集术，并且在<50年的时间内提前。结果，憩室炎是现在的主要原因之一 选修课。但是，从憩室炎发作后康复后的咨询患者受到挑战，因为少于5％的人需要紧急手术，而选择性切除后的主要发病率（5％）和复发率（5-11％）并不小。现在，一些专业社会建议延迟选修课，并呼吁进行研究以确定其价值。尽管采取了这些警告，但在过去的十年中，选修课的使用却增加了50％以上。选修切除率的速度比憩室炎的发生率更快，这与采用腹腔镜的宽度相吻合。鉴于这种出乎意料的趋势，评估与早期或相关的实践模式很重要 延迟切除，推动决策的因素以及疾病对那些做和没有选修课的人的影响。为了解决这些问题，我们提出了3个相关的研究，但独立研究描述了从急性憩室炎发作中恢复后的治疗模式，与早期和延迟的选修手术有关的因素以及疾病的结果和影响。 AIM 1使用国家索赔数据进行人群级别评估当前的护理模式与治疗憩室炎发作数量有关的当前护理模式 切割。 AIM 2将早期切除术与延迟切除的频率与旧与旧的与旧的与旧的临床因素相比，将其视为选择性切除的原因。该小组的信息有关与选修课有关的决策的信息可能有助于解释目标1中确定的实践模式。评估憩室炎对所有患有所有患有的人的影响 条件，AIM 3涉及从确认的憩室炎发作中恢复过的所有患者的全州人群，评估患者患与憩室炎，患者报告的结局以及随着时间的流逝燃烧的症状频率。这些研究将共同​​确定观察到的，急剧增加憩室炎的使用与延迟干预的建议一致，对与选择性手术的决策相关的因素提供更好的了解，并提供有关憩室炎影响的关键信息。该信息将有助于制定干预措施，以更具患者为中心的增值护理并为决策提供信息。该信息对于结肠切除和其他治疗憩室炎的比较研究也至关重要。