Comparative Analysis of Medical and Surgical Management of Diverticulitis: A Retrospective Review of the National Inpatient Sample

Introduction: While most inpatients with diverticulitis are treated nonoperatively, surgical intervention is still periodically required. We aim to compare clinical outcomes, resource utilization, and costs between the medical and surgical management of diverticulitis.

Methods: A retrospective analysis of the National Inpatient Sample (2021-2022) was conducted. Patients with a primary diverticulitis diagnosis and any associated procedures were identified using ICD-10 codes. We evaluated the influence of demographics, hospital factors, and socioeconomic status on clinical management and inpatient costs. Weighted data was used to calculate national estimates.

Results: Among 982,514 diverticulitis patients, surgical patients were younger (65 vs. 71 years), male (55% vs. 44%), and less likely to be covered by Medicare (50% vs. 68%) compared to medical patients [all p<0.001]. Surgical patients were also more likely to receive non-elective (96% vs. 90%) care at large (50% vs. 45%), urban teaching hospitals (80% vs. 73%) than medical patients [all p<0.001]. Surgical patients incurred higher inpatient costs ($29,636 vs. $17,448) and were less likely to be discharged home (50% vs. 63%) than medical patients [all p<0.001].  On adjusted analysis, patients 65-74 years (aOR 4.0) and black patients (aOR 1.81) were more likely to undergo medical management, while those treated at large (aOR 0.67), urban teaching hospitals (aOR 0.36) were more likely to undergo surgical management [all p<0.001]. Women were more likely than men to undergo medical management (aOR 1.3, p<0.001).

Conclusion: Several demographic and institutional factors influence decisions in the inpatient management of diverticulitis. Future opportunities exist to identify potential disparities in care.