Impact of diverticular disease on hospital costs and activity

Abstract

Background: Diverticulosis is very common in the UK and patients with clinically significant diverticular disease present regularly to departments of surgery as acute emergencies or chronic problems. There are no national data on the hospital prevalence, clinical implications or financial impact of diverticular disease hence the extent of the clinical problem is as yet not quantified.

Aim: To detect the prevalence, clinical implications and financial impact of diverticular disease over a one year period in a large district hospital.

Methods: Retrospective review of all patients treated for diverticular disease during one financial year. Clinical and cost analysis of inpatient and outpatient investigations, treatment and hospitalization.

Results: A total of 148 patients were treated of whom 83 were admitted for more than 1 day, 55 of those were emergency admissions. Five of 83 admitted patients died (in-patient mortality 6%, peri-operative mortality 26.3%). There was a total number of 982 hospitalization days of which 94 Intensive Care Unit days and 68 High Dependency Unit days. Nineteen operations were performed (16 sigmoid colectomies, 1 oversewing of perforated sigmoid, 2 reversal of colostomy). The investigations generated were 48 colonoscopies, 77 flexible sigmoidoscopies, 77 Barium enemas, 2 CT scans and 34 ultrasound scans. A total number of 410 clinic appointments were generated. One year after discharge 134/148 (90.5%) patients were alive. The total cost of this activity was pound 465263 or 5.3% of the total annual budget for General Surgery. Seventy percent of the cost was bed-days expenses with ICU hospitalization accounting for 25% of the total cost.

Conclusion: Diverticular disease is a major cause of morbidity in a large district hospital and a significant burden on resources. More research should be done on prevention of complications and management in the community. The current methods of management do not appear to be cost-effective and attempts should be made to produce protocols for evidence-based, cost-efficient management of the disease. A UK national audit should be undertaken.